Approval required from your insurer before you receive certain services or medications. If you get care without required prior authorization, the claim may be denied. Always check whether prior auth is required before scheduling a procedure.
Aetna publishes the clinical criteria it uses to approve or deny claims. Here is how to find the relevant bulletin and use it in your appeal.
Read articleCO-15 Prior Authorization Denial: What to Do When Your Provider Did Not Get ApprovalCO-15 means prior authorization was missing or invalid. You may not owe this bill. Here is how to determine responsibility and appeal.
Read articleHow to Appeal a Prior Authorization DenialA prior authorization denial is not final. Learn the exact steps to appeal a prior auth denial in 2026, including what documentation wins and when to escalate.
Read articleHow to Get an Urgent Prior Authorization Approved QuicklyWhen you need care fast and your insurer requires prior authorization, the standard timeline does not work. Here is how to request an expedited review and what to say.
Read articleMark Cuban Says High Deductibles Are a Scam. Here Is What to Do About It.Mark Cuban has called high deductibles a structural flaw that leaves millions of Americans paying for insurance they cannot use. He is right. Here is what patients can actually do about it.
Read articleMedicare Advantage vs Original Medicare: Why Your Denials Are DifferentMedicare Advantage plans can deny claims that Original Medicare would cover. Here is why and what appeal rights you have under each.
Read articlePre-Surgery Financial Planning ChecklistSurgery costs are predictable if you prepare. Here is a step-by-step checklist to verify coverage, get estimates, and protect yourself from surprise bills.
Read articleStep Therapy: What It Is and How to Get an ExceptionStep therapy requires you to try cheaper drugs before your insurer covers the one your doctor prescribed. Here is how it works and how to get a step therapy exception.
Read articleWhat Does Insurance Denial Code CO-50 Mean and How Do You Appeal ItCO-50 means your insurer says the service is not medically necessary. Here is what that means, why it happens, and how to fight it.
Read articleWhat Is a Formulary and How Does It Affect Your Drug CostsA formulary is your insurance plan list of covered drugs organized by tier. The tier determines your copay. Here is how formularies work and how to get exceptions.
Read articleWhy Cigna Uses EviCore and What That Means for Your Prior AuthorizationCigna outsources prior authorization decisions to EviCore for many services. Here is how that process works and how to appeal an EviCore denial.
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