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“This procedure/medication will require prior-authorization.” Words that no patient wants to hear when they are ready to proceed with a doctor-approved treatment plan for their medical concerns. However, it is one of the utilization management tools that insurance companies have developed to determine whether certain prescribed procedures, services, and medications are medically necessary, or whether there is an equally effective treatment available to the patient.

Imagine opening your mail to find a surprise bill from a medical provider due to a denied insurance claim. Now imagine that preauthorization for your child’s lifesaving procedure was denied. These are not situations that students, or anyone else, should have to worry about. A denial from the insurance company can be disheartening, but there are steps that can be taken to appeal the decision. Below is a high-level overview of the process for appealing an insurance claim.