When your insurance denial appeal, the formal process of challenging a health insurer’s decision to refuse payment for a prescribed treatment or medication. Also known as health insurance appeal, it’s your right—and often your only path—to get the care you need. Too many people give up after the first letter says "denied." But denials aren’t final. They’re just the start of a process you can win.
Most denials happen because the insurer claims the drug or treatment isn’t "medically necessary," isn’t on their formulary, or hasn’t been tried first (step therapy). But these reasons are often based on cost, not clinical evidence. For example, if your doctor prescribed a newer migraine drug like lasmiditan because triptans didn’t work for you, and the insurer says "try older drugs first," that’s a denial you can fight. You don’t need to be a medical expert—you just need to know what to say and what to ask for. The same goes for thyroid meds, diabetes drugs, or even antibiotics. Insurers sometimes deny coverage because they don’t understand your specific case. Your doctor’s note, lab results, and even past treatment failures matter more than their internal rules.
Common medication coverage denial, when a health plan refuses to pay for a prescribed drug because it’s not on their approved list or requires prior authorization. Also known as formulary exclusion, it’s one of the most frequent reasons people file appeals. You might get denied for something like levothyroxine if they push you toward a cheaper generic, or for a diabetes drug like metformin if they say you should try diet alone first. But if you’ve already tried those options and they didn’t work, that’s your evidence. You don’t have to accept their logic. You can request a copy of their medical policy, cite guidelines from the American Diabetes Association or the American Migraine Foundation, and ask for an exception. Many insurers will reverse their decision if you push back with facts.
Another big reason for denial? prior authorization, a requirement that your doctor get approval from your insurer before prescribing certain medications. Also known as pre-approval, it’s meant to control costs, but it often delays care. If your doctor didn’t submit it, or if the form was filled out wrong, your claim gets stuck. That’s not your fault—but you’re the one who suffers. You can call your insurer directly, ask for the exact reason for denial, and request a fax or email copy of their decision. Then, work with your doctor to resubmit with better documentation. Sometimes, just having the right form signed by your provider is enough.
Don’t underestimate the power of your own story. If you’ve had side effects from other drugs, if your condition worsened after a previous denial, or if your doctor says the alternative isn’t safe for you—say it clearly. Insurers respond to real-world evidence, not just clinical trials. A letter from your doctor explaining why a specific drug is essential for your health carries more weight than any automated system. And if you’re on long-term meds like lithium, cyclosporine, or anticholinergics, where side effects can be serious, your appeal isn’t just about money—it’s about safety.
You’re not alone in this. Thousands of people successfully appeal denials every month. The key isn’t yelling or complaining—it’s being organized, clear, and persistent. Know your policy. Know your rights. Know what your doctor says. And don’t let a computer-generated letter be the last word on your health.
Below, you’ll find real guides that help you understand how medications work, what to watch for, and how to talk to your doctor and insurer about them. Whether it’s figuring out why your thyroid med was denied, how to handle drug interactions, or what to do when your insurer pushes back on a biologic for arthritis—these posts give you the facts you need to fight back.
