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Denied as “not medically necessary”

What it means

The insurer's reviewer decided your treatment doesn't meet their internal criteria for being needed — often without examining you, and sometimes without a specialist in your condition looking at the file.

Why insurers use it

It's the most flexible denial reason there is. “Medical necessity” is defined by the plan's own criteria documents, which are stricter than what most treating physicians consider standard care. It shifts the burden onto you to prove your own doctor right.

The counter-strategy

1

Demand the specific criteria used to deny — you're entitled to them.

2

Get a letter of medical necessity from your treating physician that speaks to each criterion point-by-point.

3

Cite peer-reviewed guidelines (specialty society standards) that support the treatment.

4

Note the reviewer's specialty. A cardiologist denying a neurology request is an appeal argument in itself.

What the data says

In 31,504 published California external-review decisions on medical necessity denials, reviewers overturned the insurer 55.1% of the time. Source · See outcomes by treatment

Rights that apply to this denial

Right to an organization determination

Your Medicare Advantage plan must give you a written decision when it denies a service or payment. Standard requests must be decided within

42 CFR § 422.566, § 422.568; CMS-0057-F
Level 1 appeal: plan reconsideration

You have 65 days from the date on your denial notice to ask the plan to reconsider. A different reviewer than the one who denied you must de

42 CFR § 422.578–422.590
Level 2: automatic independent review (IRE)

If your plan upholds its denial, it must automatically forward your case to an Independent Review Entity — you don't have to ask. The IRE is

42 CFR § 422.590(a), § 422.592
Right to an expedited (fast) appeal

If waiting the standard timeline could seriously harm your health or your ability to function, you can demand an expedited appeal decided wi

42 CFR § 422.584
Level 3: Administrative Law Judge hearing

If the IRE also says no and the amount in dispute meets the yearly threshold, you can request a hearing before an Administrative Law Judge w

42 CFR § 422.600–422.616
ERISA internal appeal (180 days)

If your health plan comes through a private employer, federal law gives you at least 180 days to appeal a denial. The plan must review your

29 CFR § 2560.503-1(h)
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.

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