Pharmacy / Specialty Drugs

ABA Therapy Denials for Autism — How to Fight Back

ABA therapy is frequently denied and frequently won on appeal. Federal parity law and state mandates are on your side.

How to Appeal a Homeowners Insurance Claim Denial

Homeowners denials often misapply the wear-and-tear exclusion. Here is how to document and fight back.

How to Appeal a Medicare DME Denial — Wheelchairs, CPAP, and Medical Equipment

Medicare denies wheelchairs and CPAP machines at high rates. Proper documentation overturns most denials.

How to Appeal a Mental Health Coverage Denial

Step-by-step guide to appealing a mental health denial — including how to identify and use a parity violation.

Denial Code B15 — Missing or Invalid Authorization — What It Means and What to Do

Denial Code B15 means an authorization number was missing or wrong. Usually correctable at the billing level if you act fast.

Denial Code CO-16 — Claim Lacks Information — How to Correct and Resubmit

| Denial Code CO-16 means missing information. One of the most correctable denials — often fixed by resubmission alone.

Denial Code CO-109 — Claim Not Covered by This Payer — What It Means and Next Steps

Denial Code CO-109 means the claim wasn't covered by this payer. Eligibility errors and wrong submissions are common causes.

Denial Code CO-167 — Diagnosis Inconsistent with Procedure — How to Appeal

Denial Code CO-167 means diagnosis inconsistent with procedure. Usually a documentation gap — here is how to fix and appeal it.

Denial Code CO-29 — Timely Filing Limit Exceeded — Can You Still Appeal?

Denial Code CO-29 is a timely filing denial. Hard to overturn — but exceptions exist when you have proof you filed on time,

Denial Code CO-4 — Prior Authorization Required — How to Appeal

Denial Code CO-4 means prior authorization was missing. Retroactive auth and emergency exceptions can still save your claim.

What Is Denial Code CO-50 — and How Do You Beat It?

Denial code CO-50 means "not medically necessary" — the most common health insurance denial. Here is how to beat it.

Denial Code CO-58 — Treatment Not Covered by This Payer — How to Respond

Denial Code CO-58 means the service isn't covered — but exclusions must be explicit in your plan documents to hold up.

Denial Code CO-97 — Bundling and Unbundling — What It Means and How to Challenge It

Denial Code CO-97 is a bundling denial. Often correctable with the right billing modifier. Here is how to challenge it.

Denial Code OA-23 — Coordination of Benefits — How to Navigate It

Denial Code OA-23 involves two insurance plans. Submit to the primary insurer first — here is how coordination of benefit works.

Denial Code PR-96 — What It Means and How to Dispute It

Denial Code PR-96 | PR-96 means non-covered charge, but exclusions must be explicit in your plan. Here is when and how to dispute

How to Dispute a Medical Bill or Surprise Billing Charge

A significant percentage of medical bills contain errors. Here is how to dispute charges step by step.

ERISA and Employer Disability Claims — Your Federal Appeal Rights

ERISA Disability Rights | ERISA governs employer disability claims and gives you federal appeal rights.

How to File a Complaint With Your State Insurance Commissioner

Filing with your state insurance commissioner is free, triggers a review, and can force insurer compliance.

How Many People Give Up on Legitimate Appeals — and What It Costs Them

Fewer than 0.1% of denied claims are appealed — yet most would have won. Here is what giving up actually costs.

How to Appeal a Health Insurance Denial — Complete Step-by-Step Guide

How to Appeal Health Insurance Denial | A complete step-by-step guide to appealing a health insurance denial — from Level 1 up.

How to Appeal a Medicare Denial — All Four Levels Explained

A complete guide to appealing a Medicare denial — from Level 1 redetermination through federal court.

Inpatient Psychiatric Care Denials — Your Appeal Rights

Psychiatric care denials happen at alarming rates. Parity law gives you strong grounds — here are your rights.

How Often Do Insurance Appeals Succeed? The Data

Fewer than 1 in 1,000 people appeal insurance denials. Yet 40–60% of those who do win. Here is the data.

The Complete Insurance Denial Code Library — What Every Code Means

The ClaimCompass Denial Code Library translates every major insurance denial code and tells you exactly what to do.

Insurance Denial Rates by State — What the Data Shows

Denial rates vary widely by state. Here is what the data shows and what it means for your appeal.

Internal Appeal vs. External Review — What Is the Difference?

| Internal appeals go back to your insurer. External review goes to an independent third party with binding authority.

Medicare Appeals — Your Four-Level Right to Appeal Explained

Every Medicare denial can be appealed through four levels — including a hearing before an independent judge.

Medicare and Medicaid — Your Appeal Rights Explained

Medicare and Medicaid have strong appeal rights most beneficiaries never use. Here is what they actually are.

Medicare Part D Prescription Drug Denials — How to Fight Back

Part D prescription denials — formulary exclusions, step therapy, prior auth. Here is how to appeal each one.

Mental Health Coverage Denials — By the Numbers

Mental health claims are denied at rates 3–5x higher than medical claims. Here is what the research shows.

Mental Health Parity Act — Explained in Plain English

Your insurer must cover mental health the same as physical health. When it doesn't, that is a federal violation.

Your Rights Under the Mental Health Parity Act

Mental Health Parity Act Rights | Federal law requires equal mental health coverage. Most insurers violate it. Here is how to use

The No Surprises Act — What It Covers and What It Doesn't

The No Surprises Act bans surprise out-of-network bills in emergencies — but has significant gaps. Here is what it covers:

How to Request a Peer-to-Peer Review With Your Insurer

A peer-to-peer review can overturn a denial in days — before a formal appeal is ever filed. Here is how.

What Is Prior Authorization — and How Do You Appeal a Denial?

What Is Prior Authorization | Prior auth denials are fast-growing. Here is what they mean and how to challenge one with a medical

State-by-State Insurance Appeal Guides — Appeal Deadlines, Rights, and Resources

Every state has its own appeal rules, deadlines, and consumer protections. Here is what matters for your location.

Substance Abuse Treatment Denials — Parity Law Explained

Federal parity law requires equal coverage for substance use treatment. Here is how to use it in your appeal.