The whole site, in eight doors
Each one lists everything inside it, with what it applies to and any deadline attached.
- Getting approvedAll plan types. Whether prior authorization is required, and who submits it, is set by your plan and your clinic rather than by federal law.
- DenialsAll plan types. The answer differs by denial reason more than by plan.
- AppealsAll plan types, with route differences noted on each page.
- Plan typesEveryone. This is the sorting question the rest of the site depends on.
- The paperworkAll plan types.
- TemplatesAll plan types. Addresses and deadlines come from your own denial letter.
- StatesFully insured and state Medicaid plans. Self-funded employer plans are governed federally and state mandates do not reach them.
- PrivacyAnyone on someone else's policy, and anyone sharing an address.
Go straight to your plan type
If you already know which one you have.
What your denial says
7 shapes a denial takes. Which one you got decides the whole argument.
Reading the paperwork
The denial letter, the explanation of benefits, and the plan document that governs both.
Appealing it
17 pages, in the order you meet them. All of them, with what each applies to.
The arguments
What to gather
When it goes further, and what comes after
Templates you can fill in
Fill in the bracketed fields from your own letter. Nothing is submitted anywhere.
Look things up yourself
11 of them: the same public databases an insurer’s own staff use, searchable here. Nothing you type is recorded.
- Reviewer lookupDenials that turned on clinical judgment, once you have asked the plan for the reviewer's name.
- Medical evidenceDenials that say not medically necessary, experimental, investigational, or cosmetic.
- Court casesAnyone building an argument. Most useful at external review, or with a lawyer or advocate.
- Deadline calculatorEvery plan type this site sorts by. Where there is no federal number to count from, the tool says so and explains why rather than guessing an answer.
- Provider countsAnyone told their surgeon is out of network, or asking for a gap exception.
- Insurer recordAnyone weighing a state complaint alongside an appeal.
- Medication labelsDenials of hormones or blockers as experimental, unproven, or not medically necessary.
- What's changingAnyone wondering whether what they read here is still true.
- SourcesEverything on this site that states what the law requires.
- Connect the dataAnyone who wants to search this data directly, and anyone building something better.
- StatesFully insured and state Medicaid plans. Self-funded employer plans are governed federally and state mandates do not reach them.
What has changed recently
RSSFederal rules on this care have moved repeatedly. Each note says what changed and, just as importantly, what it does not reach.
Everything that has changed