This specific treatment was not authorized by your plan. Different from a prior authorization issue -- this means the treatment itself falls outside covered benefits.
Review your plan documents to confirm whether this treatment is excluded. If you believe it should be covered, appeal with clinical documentation and reference any applicable state mandates that may require coverage.
Appeal outlook: Moderate depending on plan type and state
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Bill Advantage can analyze your denial and generate a ready-to-send appeal or dispute letter in minutes.
Open Denial Letter TranslatorDenial codes on your EOB explain why a claim was denied. Learn what the most common codes mean in 2026 and the exact steps to fix or appeal each one.
Read articleWhat to Do When Insurance Denies a ClaimInsurance denied your claim? Learn the exact steps to appeal a health insurance denial in 2026, from reading the denial letter to external independent review.
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