How to appeal a Priority Health denial

To appeal a Priority Health denial, file an internal appeal within 180 days of the date on the denial letter; Priority Health 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 Priority Health-specific filing window, decision timeline, common denial reasons, and how to submit your appeal.

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