How to appeal a Highmark denial

To appeal a Highmark denial, file an internal appeal within 180 days of the date on the denial letter; Highmark returns standard decisions in 30 days, and if it upholds the denial you can request an independent external review within 4 months. Pick your treatment below for a step-by-step guide.

Appeal guides by treatment

Each guide covers the Highmark-specific filing window, decision timeline, common denial reasons, and how to submit your appeal.

• Highmark glp-1 weight-loss drugs denial →
• Highmark mental health & behavioral health denial →
• Highmark fertility & ivf denial →
• Highmark adult adhd medications denial →
• Highmark specialty biologics denial →
• Highmark cancer treatments denial →
• Highmark ms treatments denial →
• Highmark surgery denied as 'not medically necessary' denial →
• Highmark out-of-network emergency denial →
• Highmark migraine cgrp inhibitors denial →
• Highmark pediatric therapy denial →
• Highmark continuous glucose monitors & insulin pumps denial →
• Highmark genetic testing denial →
• Highmark hepatitis c cures denial →
• Highmark sleep medicine — cpap, bipap, asv, oral appliances, inspire hns denial →
• Highmark dme — wheelchairs, prosthetics, orthotics denial →
• Highmark dental — medical necessity, oral surgery, tmj, cleft palate denial →
• Highmark interventional pain — scs, rfa, esi, kyphoplasty denial →
• Highmark substance use disorder treatment (sud/moud) denial →
• Highmark rare disease — ert, substrate reduction, gene therapy denial →
• Highmark hiv prep & hiv treatment denial →
• Highmark hearing aids, cochlear implants, baha denial →
• Highmark hemophilia & bleeding disorders denial →
• Highmark cystic fibrosis & pulmonary fibrosis denial →
• Highmark cardiology drugs denial →
• Highmark cardiac devices & procedures denial →
• Highmark neurology — alzheimer's, parkinson's, als, epilepsy denial →
• Highmark sickle cell & thalassemia denial →
• Highmark vision & retinal — anti-vegf, ga, gene therapy denial →
• Highmark kidney disease — ckd, esrd, igan, adpkd denial →
• Highmark endocrine (non-diabetes) denial →
• Highmark liver (non-hcv) — nash/mash, pbc, aih, wilson denial →
• Highmark women's health — menopause, endometriosis, pcos, ppd denial →
• Highmark copd severe + alpha-1 antitrypsin deficiency denial →
• Highmark diabetes drugs & insulin denial →
• Highmark asthma & severe allergies denial →
• Highmark orthopedics & sports medicine denial →
• Highmark gerd & severe reflux denial →
• Highmark ibs & functional gi denial →
• Highmark eating disorders — residential / php / iop denial →
• Highmark osteoporosis denial →
• Highmark long covid / pasc denial →
• Highmark severe acne denial →
• Highmark eosinophilic esophagitis (eoe) denial →
• Highmark iv iron infusion denial →
• Highmark hereditary angioedema (hae) denial →
• Highmark compounded glp-1 denial →
• Highmark pediatric oncology denial →
• Highmark maternity & postpartum denial →
• Highmark stroke & neuro rehab denial →
• Highmark lupus & rheumatology denial →
• Highmark chronic wound care denial →
• Highmark immune globulin (ivig/scig) for pidd denial →
• Highmark adult car-t cell therapy denial →
• Highmark myasthenia gravis & cidp denial →
• Highmark pulmonary hypertension denial →
• Highmark amyloidosis (cardiac attr + al) denial →
• Highmark spinal muscular atrophy denial →
• Highmark autoimmune cytopenias (itp + aiha) denial →
• Highmark c. difficile infection denial →
• Highmark solid-organ transplant denial →
• Highmark men's sexual health — trt + ed denial →
• Highmark treatment-resistant depression — rtms, spravato, ect denial →
• Highmark inflammatory bowel disease (crohn's + uc) denial →
• Highmark plaque psoriasis + psoriatic arthritis denial →
• Highmark atopic dermatitis (ad / eczema) denial →
• Highmark glaucoma (drops + procedures + surgery) denial →
• Highmark multiple myeloma (non-car-t) denial →
• Highmark prostate cancer denial →
• Highmark melanoma & melanoma-immunotherapy denial →
• Highmark pediatric epilepsy denial →
• Highmark growth hormone replacement therapy denial →
• Highmark bph procedures + medical therapy denial →
• Highmark lymphoma & leukemia (heme malignancies) denial →
• Highmark bone marrow transplant (allogeneic hsct) denial →
• Highmark neurosurgery — discectomy, laminectomy, craniotomy, shunt denial →
• Highmark radiation oncology — proton, sbrt, brachytherapy, imrt, iort denial →
• Highmark thyroid eye disease (ted) — tepezza (teprotumumab) and igf-1r therapy denial →
• Highmark compounded medications (non-glp-1) — bhrt, ldn, ketamine, custom-dose pediatrics denial →
• Highmark ent / otolaryngology — sinus surgery, septoplasty, tonsillectomy, head & neck denial →
• Highmark vascular & endovascular — aaa, carotid, pad, varicose veins, ivc filters denial →
• Highmark bariatric surgery — rygb, sleeve, duodenal switch, sadi-s, revision, esg denial →
• Highmark interventional radiology — ufe, pae, tips, y-90, tumor ablation, kyphoplasty denial →
• Highmark neuropsychological & psychological testing — adhd, tbi, dementia, asd, presurgical eval denial →
• Highmark mohs surgery & dermatologic surgery — bcc, scc, melanoma in situ, slnb, pdt denial →
• Highmark pediatric subspecialty — cardiology, gi, pulmonology, rheumatology, endocrinology, neurology denial →
• Highmark reconstructive plastic surgery — lymphedema, panniculectomy, burn, mohs, hand denial →
• Highmark inpatient rehab — irf / snf / ltac admission and length-of-stay denial →
• Highmark hospice / palliative — eligibility, gip, recertification, concurrent care denial →
• Highmark home healthcare — home nursing, home infusion, home pt/ot/slp, home aide, hospital-at-home denial →