Addiction Care · 3 min read · Updated November 13, 2026
An insurance denial does not always mean there are no further options. The next step depends on why the service was denied, which plan you have, and whether the situation is urgent. Start with the written notice rather than trying to solve the problem from a brief telephone summary.
Find the reason and the deadline
Ask for the denial letter or explanation of benefits and identify the service, dates, claim number, reason, and appeal instructions. A missing document is different from a finding that a service is not medically necessary or not covered by the plan. HealthCare.gov: Appealing a Health Plan Decision describes rights to ask for reconsideration and, in applicable situations, independent review. Medicare, Medicaid, employer plans, and other coverage arrangements can have different procedures. Follow the notice for your specific plan and decision.
Ask the provider to address the actual reason
Give the clinical and billing teams a copy of the notice. Ask whether a correction, additional records, or a medical-necessity explanation is needed. A clinician can explain the recommended care and why an alternative may not meet your needs; a billing team may be able to correct an administrative error. Our prior authorization guide can help distinguish a pending approval from a formal denial. Those should not be treated as interchangeable.
Build a clear appeal file
Keep the notice, plan documents, authorization records, relevant clinical letters, and a timeline of calls. Write down names, dates, and reference numbers. HealthCare.gov: Internal Appeals describes an internal appeal process and the value of submitting supporting information. Your plan’s deadlines and required forms matter, so do not assume a general online deadline applies to every type of coverage. If someone is helping you, ask whether the insurer needs a signed authorization for that person to act on your behalf.
Ask about urgent review and care while waiting
If delaying treatment could seriously affect health, ask the clinician and insurer whether an expedited review is available. Do not postpone emergency medical assessment while working through an appeal. For non-emergency care, ask what clinically appropriate support can continue during review and what costs you could face if you proceed before coverage is resolved. Our sliding-fee guide offers questions about financial assistance, but assistance should not be assumed or used to replace a needed clinical plan.
Follow the next decision carefully
If the appeal is unsuccessful, read the explanation for further review options and deadlines. A state insurance department, consumer assistance program, Medicare counselor, or Medicaid plan contact may be able to explain the applicable process. Keep original documents and proof of submission. An appeal is a request for review, not a guarantee of approval. The practical goal is to make the insurer address the correct information while your care team helps you plan the safest available next step.
Sources & further reading
General educational information. This guide is not a substitute for advice from a qualified treatment professional.
