Insurance denied my surgery — what do I do?

Most surgery denials are based on the plan's medical-necessity criteria — and most are reversible with the right documentation. The denial letter you received MUST state the specific reason (federal law requires this under ERISA §503 + 29 CFR §2560.503-1). Read it carefully.

1. Read the denial letter and find the SPECIFIC denial reason (not generic 'not medically necessary'); 2. Ask the plan for a copy of the specific internal rule, guideline, protocol, or other criterion it relied on (you have this right under ERISA §503); 3. Get the surgeon's office to submit additional clinical documentation if the chart supports it; 4. File a formal internal appeal within 180 days (federal floor); 5. If denied, request external review by an Independent Review Organization (ACA §2719) — the IRO's decision is binding on the plan; 6. DenialHelp can draft the appeal letter in 5 minutes citing the right federal regulation + specialty-society guideline