AKA: Appealing a Denial
The process of challenging an insurance company’s decision to deny coverage for a service or medication.
In the context of addiction treatment:
Appeals are common when insurers say a higher level of care (like residential) or a certain medication isn’t “medically necessary.”
What to know:
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You usually have the right to one or more levels of appeal, with specific timelines.
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Strong documentation from your treatment team (ASAM criteria, risk assessments, medical history) makes appeals stronger.
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Some states allow an independent external review if internal appeals fail.
Example:
Your insurer denies more days in residential care; your doctor submits an appeal letter explaining your recent relapse and high overdose risk.