How to appeal a Regence denial

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

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