How to appeal an UPMC Health Plan denial

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

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