How and Why To Appeal Your Prior Auth Denials

We’ve all seen the headlines. We’ve all felt the frustration. And yet… prior authorization denials are still not being appealed.

The Facts:
- Only about 11% of denials are ever appealed.
- Of those appeals, roughly 90% are overturned.

That means payers are banking on us not fighting back. And too often, they’re right.

WHY YOU SHOULD APPEAL
- High odds of success: 9 out of 10 appeals get overturned when challenged.
- Protect patient care: Denials delay or block necessary treatment. Appeals keep care on track.

Protect your revenue: Every overturned denial is revenue rightfully earned for services already delivered.

HOW TO APPEAL
1. Act fast- File within the payer’s deadline (usually 30–60 days).
2. Be thorough-Address the denial reason directly, quote payer policy and highlight contradictions.
3. Use strong clinical documentation- Include notes, referrals, test results and progress reports to prove medical necessity.
4. Standardize your process- Create a template for common denials so your team isn’t starting from scratch each time.
5. Follow up- Like our normal authorization requests, track every appeal and escalate when payers don’t respond. Persistence matters!

The truth is simple: appealing isn’t just paperwork- it’s advocacy... For your patients. For your practice. For the care that matters.