Who denied you changes how you fight it.

The largest US insurer — heavy on prior authorization and pharmacy review.

Elevance's Blue-branded plans — medical-necessity and prior-auth denials.

CVS Health's insurer — and one of the highest MA overturn rates on record.

Medical-necessity and pharmacy (Express Scripts) denials.

Medicaid, ACA (Ambetter) and Medicare (Wellcare) — top MA overturn rate.

Medicare Advantage heavyweight — the MA appeal levels matter most here.

Integrated plan-and-provider — appeals can run through a different venue.

Dozens of independent local Blue plans — one federal appeal path, local medical policy.

Medicaid-heavy plans — the appeal path depends on whether it’s Medicaid, Marketplace, or Medicare.

A Marketplace-focused insurer — denials follow the standard internal-then-external path.

A Blue licensee across PA, WV, DE, and parts of NY — the standard federal appeal path.

New Jersey’s Blue plan — the federal appeal path plus NJ’s external-review program.

The Blue plan for Maryland, DC, and Northern Virginia — standard federal appeal path.

Florida’s Blue plan — the standard federal path plus Florida’s external-review program.

Prior authorization drives most MA denials — and a 2024 rule made many of them easier to overturn.

Fee-for-service Medicare runs a five-level appeal — starting with the contractor that paid the claim.

An internal plan appeal, then a state fair hearing — with the right to keep benefits during it.

A Centene Medicare and Medicaid brand — the appeal path depends on which program.

A Medicaid-focused plan — internal appeal, then a state fair hearing, with continued benefits.

A nonprofit Medicaid and Marketplace plan — the path depends on the program.

The military health program — its own appeal levels, a 90-day clock, and a $300 hearing threshold.

Federal-employee plans — appeal the carrier first, then ask OPM to review.