How to Appeal an MRI Prior Authorization Denial

Free sample appeal paragraph

I am writing to request an internal appeal of the decision dated [date] denying coverage for [service] (claim [number]). The denial cited mri pa. My physician, [name], has determined this service is medically necessary because [clinical reason], as documented in the enclosed records. I request that you reconsider and approve coverage, and that you send me the clinical criteria used in this decision.

Replace the [brackets] with your details. This is a starting point, not legal advice.

What to do

• Read the denial letter for deadlines, codes and the appeal address.
• Request the claim file and the clinical criteria used.
• Ask your clinician for a letter of medical necessity.
• File a timely internal appeal and keep proof of submission.
• If denied again and eligible, consider independent external review.

Frequently asked questions

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