What to do when...

Yes — most denials are reversible without an attorney. Here's how.

Yes, you can — but ERISA preemption changes the rules. Here's what to know before filing suit.

COBRA costs the full premium plus 2% admin fee — often $700-$2,000/month per person. Better options usually exist.

Surgery denials are usually appealable. Here's the step-by-step.

Plans frequently misclassify medically necessary procedures as cosmetic. Many are appealable.

Likely a formulary tier change. You may have rights to push back.

Federal law requires denial letters to be understandable. If yours isn't, request a corrected one.

Mid-year formulary changes are common and often appealable. You have specific rights.

Don't panic. Most surgery payment disputes are reversible with the right appeal.

ACA §2713 protects screening status when an incidental finding is made. Appeal.

Yes — the No Surprises Act bans balance billing for emergency services and out-of-network providers at in-network facilities.

Document the prior trial + failure. Most step-therapy denials reverse on appeal with this documentation.

Plans cannot require prior auth for emergency services. ACA §2719A + Prudent Layperson Standard.

Specialty pharmacy refusal usually means a prior-auth or formulary issue. Diagnose then fight.

It's the plan's most common appealable denial — and it doesn't mean the service isn't needed. Here's what it actually means and how to fight it.