Denial Reply appeal paperwork for denied back and neck surgery and scans, for adults in Texas

Decode your denial letter

No name, no member number, no upload, no account. Nothing you type here is stored or sent to an AI model: the answer comes from fixed rules on this server.

Type what your letter says and get back: the appeal right that applies and its source, your deadline counted from the letter date, whether this kind of denial is the kind an appeal packet addresses, the plan rules we have read, and the two next steps.

If your care is scheduled within 7 days, call the number on your letter now and ask for an expedited appeal.

1. What kind of health plan denied it? A plan through my job (or a family member's job) A marketplace (HealthCare.gov) or other individual plan A Medicare Advantage plan Something else, or I am not sure

2. The reason your letter gives (pick one, or paste one sentence from the letter) Not medically necessary, does not meet clinical criteria, or "try other treatment first" Prior authorization was not obtained or is not on file Experimental, investigational or unproven Coding, billing, missing information, duplicate claim or timely filing Out of network, and the plan offers a network exception (or I will ask for one) Out of network, and no network exception is offered A benefit exclusion: the plan says the service is excluded under the plan document Not a covered benefit Cosmetic Something else: I will paste one sentence from my letterOne sentence from the letter (only if you picked “something else”):

3. The date printed on the letter:

4. Is the care already done, or still pending? Not done yet (the plan denied it before the care) Already done (the plan denied the bill afterwards)

5. Is the care scheduled within the next 7 days? Yes No

6. Two questions that tell which outside-review route applies (optional)

Does your insurance card say "TDI" or "DOI" on it?

Yes No I do not know

Does your letter mention ERISA, or your right to bring a "civil action under section 502(a)"?

Yes No I do not know

Pressing the button sends these answers to our server once, to compute the result. They are not logged and not kept. Records come in only if you decide to start a packet.