What were you denied?
Pick the treatment or service your insurer denied and we’ll start the right appeal. Don’t see yours? Choose the closest match — we route it from there.
Medications & prescriptions
Cardiology drugsPCSK9, Entresto, SGLT2, Vyndamax, Camzyos, Kerendia, VascepaCompounded GLP-1503A/503B compounded sema/tirz from telehealth — coverage exception + retroactive reimbursement appealsCompounded medications (non-GLP-1) — BHRT, LDN, ketamine, custom-dose pediatricsBioidentical hormone replacement, low-dose naltrexone, compounded ketamine, custom-dose pediatric, niche specialty compounded preparationsDiabetes drugs & insulinInsulin analogs, GLP-1 for T2D, SGLT2, DPP-4, Afrezza, pump supplies, glucagon rescueGLP-1 weight-loss drugsWegovy, Zepbound, Mounjaro, Ozempic, SaxendaHepatitis C curesMavyret, Epclusa, Vosevi, Harvoni — DAA appealsHIV PrEP & HIV treatmentTruvada, Descovy, Apretude PrEP; Biktarvy, Dovato, Cabenuva treatmentInterventional pain — SCS, RFA, ESI, kyphoplastySpinal cord stimulators, intrathecal pumps, RFA, ESI, SI fusionMigraine CGRP inhibitorsAimovig, Ajovy, Emgality, Vyepti, Qulipta, Nurtec, BotoxSevere acneIsotretinoin (Accutane), Seysara, Aklief, Winlevi, Absorica LD, hormonal, scar revisionSpecialty biologicsHumira, Enbrel, Stelara, Skyrizi, Cosentyx, Rinvoq, Dupixent
Cancer & oncology
Adult CAR-T cell therapyYescarta, Kymriah, Tecartus, Breyanzi, Carvykti, AbecmaBone marrow transplant (allogeneic HSCT)Conditioning, MUD/Haplo/UCB donor selection, GVHD prophylaxis + treatment, Defitelio, COE accessCancer treatmentsChemo, immunotherapy, CAR-T, proton, PET, off-label per NCCNLymphoma & leukemia (heme malignancies)BTKi, BCL2, bispecifics, ADCs, IDH/FLT3 inhibitors, JAK, HMA, TKIs — CLL/HL/NHL/AML/CML/MPN/MDS/ALL/T-cellMelanoma & melanoma-immunotherapyKeytruda, Opdivo, Yervoy, Opdualag, BRAF/MEK combos, Amtagvi (TIL), Kimmtrak, Imlygic, neoadjuvant + adjuvantMultiple myeloma (non-CAR-T)Anti-CD38, BCMA / GPRC5D bispecifics, IMiDs, proteasome inhibitors, selinexor, ASCT, maintenancePediatric oncologyCOG trials, CAR-T, proton therapy, out-of-state center coverage, fertility preservationProstate cancerPluvicto, ARSI escalation, PARPi, ADT, sipuleucel-T, PSMA-PET, focal therapyRadiation oncology — proton, SBRT, brachytherapy, IMRT, IORTProton beam, SBRT, LDR/HDR brachytherapy, IMRT escalation, IORT, MRI-LINAC
Mental health & neurology
Adult ADHD medicationsVyvanse, Adderall, Concerta, Strattera, QelbreeEating disorders — residential / PHP / IOPAN, BN, BED, ARFID at all levels of care — APA 2023 + AED + MHPAEA parity law + Wit v. UBHLong COVID / PASCMultidisciplinary clinic, POTS, MCAS, LDN, Paxlovid extended, HBOT, cognitive rehabMental health & behavioral healthInpatient psych, residential, PHP/IOP, therapy, TMS, SpravatoMS treatmentsOcrevus, Kesimpta, Tysabri, Mavenclad, HSCTMyasthenia gravis & CIDPVyvgart, Ultomiris, Soliris, Rystiggo, Zilbrysq, Hizentra-CIDP, IVIG/PLEX, rituximabNeurology — Alzheimer's, Parkinson's, ALS, epilepsyLeqembi, Kisunla, Rytary, Qalsody, Epidiolex, Austedo, DBSNeuropsychological & psychological testing — ADHD, TBI, dementia, ASD, presurgical evalComprehensive neuropsych battery, ADHD diagnosis, post-concussion / TBI workup, dementia workup, ASD evaluation, presurgical eval (epilepsy / DBS / bariatric), learning disability evalPediatric epilepsyDravet, LGS, infantile spasms, TSC, refractory pediatric focal — Epidiolex, Fintepla, Diacomit, Ztalmy, ACTH, Sabril, VNS, surgerySubstance use disorder treatment (SUD/MOUD)MOUD (Suboxone, Sublocade, methadone, Vivitrol), residential, detoxTreatment-resistant depression — rTMS, Spravato, ECTNeuroStar / Brainsway / iTBS / SAINT, Spravato (esketamine), ECT, VNS for TRD, OCD, suicidality
Autoimmune & inflammatory
Asthma & severe allergiesXolair, Dupixent, Nucala, Tezspire, Neffy, Palforzia, EpiPen, allergy immunotherapyAtopic dermatitis (AD / eczema)Dupixent, Adbry, Ebglyss, Nemluvio, Cibinqo, Rinvoq, Opzelura, Eucrisa, Zoryve, phototherapyHereditary angioedema (HAE)Takhzyro, Orladeyo, Haegarda, Cinryze prophylaxis + Berinert, Firazyr, Ruconest, Kalbitor on-demandInflammatory bowel disease (Crohn's + UC)TNFi, Stelara, Skyrizi, Tremfya, Entyvio, Rinvoq, Xeljanz, Zeposia, Velsipity, 5-ASA, TDM, surgeryLupus & rheumatologyBenlysta, Saphnelo, Lupkynis, hydroxychloroquine, MMF, rituximab, cyclophosphamidePlaque psoriasis + psoriatic arthritisTNFi, IL-17, IL-23, IL-12/23, TYK2, JAK, PDE-4, topicals, phototherapy, biosimilarsThyroid eye disease (TED) — Tepezza (teprotumumab) and IGF-1R therapyTepezza for TED / Graves orbitopathy — active and chronic-stable disease, IGF-1R alternatives
Cardiovascular & pulmonary
Cardiac devices & proceduresICD/CRT, TAVR, Watchman, MitraClip, LVAD, ablations, cardiac imagingCOPD severe + alpha-1 antitrypsin deficiencyTrelegy, Breztri, Dupixent (COPD), Ohtuvayre, Prolastin-C, Glassia, Zemaira, lung volume reductionCystic fibrosis & pulmonary fibrosisTrikafta / Kalydeco CFTR modulators, Ofev/Esbriet antifibroticsPulmonary hypertensionPAH (Group 1), CTEPH (Group 4), PH-ILD (Group 3) — ERAs, PDE5i, riociguat, prostacyclins, sotatercept
GI, liver, kidney & endocrine
Bariatric surgery — RYGB, sleeve, duodenal switch, SADI-S, revision, ESGRoux-en-Y gastric bypass, sleeve gastrectomy, BPD/DS, SADI-S, revision bariatric surgery, endoscopic sleeve gastroplastyC. difficile infectionFidaxomicin, vancomycin, bezlotoxumab, Rebyota, Vowst, FMT — initial CDI + recurrence preventionContinuous glucose monitors & insulin pumpsDexcom, FreeStyle Libre, Omnipod 5, t:slim X2, Tandem Mobi, MiniMed 780G, iLetEndocrine (non-diabetes)Cushing's, acromegaly, growth hormone, hypogonadism/TRT, CAH, TED, hypoPTHEosinophilic esophagitis (EoE)Dupixent, Eohilia, swallowed steroids, PPI, elimination diets, dilationGERD & severe refluxVoquezna, branded PPIs, LINX, TIF, Nissen / Toupet, Barrett surveillance + RFAGrowth hormone replacement therapyDaily somatropin, weekly long-acting GH (Skytrofa / Sogroya / Ngenla), Increlex (IGF-1), macimorelin diagnostic — pediatric and adult GHD, Turner, SHOX, ISS, SGA, Prader-Willi, Noonan, CKD, HIV wastingIBS & functional GILinzess, Trulance, Xifaxan, Viberzi, Motegrity, OIC PAMORAs, Gimoti for gastroparesisKidney disease — CKD, ESRD, IgAN, ADPKDTarpeyo, Filspari, SGLT2i for CKD, ESAs, HIF-PHIs, Jynarque, transplantLiver (non-HCV) — NASH/MASH, PBC, AIH, WilsonRezdiffra (NASH), Iqirvo / Livdelzi / Ocaliva (PBC), Bylvay/Livmarli, terlipressinOsteoporosisProlia, Evenity, Forteo, Tymlos, Reclast, oral bisphosphonates, DEXA, kyphoplasty
Rare & specialty conditions
Amyloidosis (cardiac ATTR + AL)Vyndaqel/Vyndamax, Attruby, Amvuttra, Wainua, Onpattro, D-VCd for AL, ASCT, diflunisal-doxycycline, PYP/biopsy/genotype workupAutoimmune cytopenias (ITP + AIHA)ITP, warm AIHA, cold-agglutinin disease, Evans — TPO-RAs, Tavalisse, Wayrilz, Enjaymo, rituximab, IVIG, splenectomyGenetic testingBRCA, hereditary cancer panels, NIPT, tumor profiling, MRDHemophilia & bleeding disordersFactor VIII/IX, Hemlibra, Roctavian, Hemgenix gene therapyImmune globulin (IVIG/SCIG) for PIDDPrivigen, Gamunex-C, Octagam, Gammagard, Flebogamma, Bivigam, Asceniv, Panzyga, Hizentra, Cuvitru, Xembify, Cutaquig, HyQvia for primary immunodeficiencyIV iron infusionInjectafer, Monoferric, Feraheme, Venofer for IDA — when oral iron isn't an optionPediatric subspecialty — cardiology, GI, pulmonology, rheumatology, endocrinology, neurologyCatch-all for pediatric subspecialty denials: peds cardiology (congenital, Kawasaki, ECMO), peds GI (EoE, IBD), peds pulm (asthma, BPD), peds rheum (JIA, juvenile lupus, KFD), peds endo (diabetes, growth, thyroid), broader peds neurologyRare disease — ERT, substrate reduction, gene therapyPompe, Fabry, Gaucher, MPS, Batten, NPC, PKUSickle cell & thalassemiaCasgevy, Lyfgenia, Zynteglo gene therapies + hydroxyurea + chelationSolid-organ transplantKidney, liver, heart, lung — induction + maintenance + rejectionSpinal muscular atrophySpinraza, Evrysdi, Zolgensma + supportive
Women's, men's & reproductive
Fertility & IVFIVF, IUI, fertility preservation, PGT, donor cyclesMaternity & postpartumNIPT, breast pump, lactation, hyperemesis, 17-OHP, postpartum mental health, Tdap/AbrysvoMen's sexual health — TRT + EDTestosterone replacement (cypionate, gel, pellets, oral undecanoate) + PDE5 inhibitors, intracorporeal alprostadil, vacuum, penile implant, Peyronie'sWomen's health — menopause, endometriosis, PCOS, PPDVeozah, Zurzuvae, Orilissa, Myfembree, Oriahnn, mirabegron, Solosec
Procedures, devices & rehab
BPH procedures + medical therapyUroLift, Rezum, Aquablation, Optilume BPH, GreenLight, HoLEP, TURP, PAE, simple prostatectomy + alpha-blockers / 5-ARIs / tadalafil / mirabegronChronic wound careHBOT, NPWT (wound vac), skin substitutes (Apligraf / Dermagraft / EpiFix / Grafix), TCC, debridement, compression, IDSA antibiotics for DFIDental — medical necessity, oral surgery, TMJ, cleft palateAdult ortho, implants, oral surgery, TMJ, pre-radiation/transplant clearanceDME — wheelchairs, prosthetics, orthoticsPower chairs, manual chairs, prosthetic limbs, hospital beds, AFOsENT / Otolaryngology — sinus surgery, septoplasty, tonsillectomy, head & neckFESS, balloon sinuplasty, septoplasty, turbinate reduction, tonsillectomy/adenoidectomy, head & neck cancer surgery, voice / laryngology, ear proceduresGlaucoma (drops + procedures + surgery)PGAs, Vyzulta, Rhopressa, Rocklatan, SLT, MIGS (iStent / Hydrus / Xen / OMNI / KDB), trabeculectomy, tube shunts, Durysta, iDose TRHearing aids, cochlear implants, BAHAConventional hearing aids, OTC, BAHA, cochlear implants, ABI, pediatric audiologyHome healthcare — home nursing, home infusion, home PT/OT/SLP, home aide, hospital-at-homeHome nursing (skilled vs custodial), home infusion (IVIG, biologics, antibiotics, TPN), home PT/OT/SLP, home health aide, hospital-at-home (CMS AHCAH)Hospice / palliative — eligibility, GIP, recertification, concurrent careHospice eligibility (6-mo prognosis), palliative consults, GIP level of care, recert, hospice revocation, ACA §2302 concurrent careInpatient rehab — IRF / SNF / LTAC admission and length-of-stayIRF admission, SNF coverage, LTAC admission, level-of-care downgrades, 60% rule, length-of-stayInterventional radiology — UFE, PAE, TIPS, Y-90, tumor ablation, kyphoplastyUterine fibroid embolization (UFE), prostate artery embolization (PAE), TIPS, Y-90 radioembolization, cryoablation / RFA for tumors, vertebroplasty / kyphoplastyMohs surgery & dermatologic surgery — BCC, SCC, melanoma in situ, SLNB, PDTMohs micrographic surgery, excision with margins, sentinel lymph node biopsy for melanoma, photodynamic therapy, surgical reconstruction post-Mohs, scar revision (medical necessity)Neurosurgery — discectomy, laminectomy, craniotomy, shuntDiscectomy, lumbar/cervical fusion, ACDF, CADR, craniotomy, VP shunt, Chiari decompressionOrthopedics & sports medicineJoint replacement, ACL/meniscus/rotator cuff, MACI cartilage, PRP/stem cell, robotic-assisted, ADROut-of-network emergencyER, surprise bills, ambulance — No Surprises Act protectionsPediatric therapyABA, speech, OT, PT, feeding therapyReconstructive plastic surgery — lymphedema, panniculectomy, burn, Mohs, handDIEP/VLNT/LYMPHA, panniculectomy/abdominoplasty, burn reconstruction, Mohs reconstruction, hand reconstruction, pediatric reconstructiveSleep medicine — CPAP, BiPAP, ASV, oral appliances, Inspire HNSPAP devices, sleep studies, narcolepsy meds, oral appliances, hypoglossal stimStroke & neuro rehabAcute thrombectomy, IRF, robotic gait, Botox spasticity, CIMT, lifelong post-stroke rehabSurgery denied as 'not medically necessary'Bariatric, spine, gender-affirming, hysterectomy, TJRVascular & endovascular — AAA, carotid, PAD, varicose veins, IVC filtersEVAR / open AAA, CEA / CAS, peripheral arterial disease endovascular, endovenous ablation (RFA / laser / sclerotherapy), IVC filtersVision & retinal — anti-VEGF, GA, gene therapyEylea, Vabysmo, Avastin, Syfovre, Izervay, Luxturna, premium IOLs, glaucoma