All guides · Insurer-specific guides
Insurer-specific guides
How appeals work at each of the major US insurers — UnitedHealthcare, Aetna, Cigna, BCBS, Kaiser, and more.
Walks through Aetna's publicly-published Clinical Policy Bulletins, internal utilization-review flow (nurse → medical director), denial-letter language to decode, and the IRO external review path.
UnitedHealthcare denied my claim — full playbookDecodes UHC's appeal levels, the role of Optum/OptumRx/Optum Behavioral Health in clinical review, the peer-to-peer-review option, and Provider Portal vs member appeals path.
Cigna denial appeals explainedExplains Cigna's centralized appeals unit, Evernorth/Express Scripts/Accredo involvement on pharmacy denials, and how to dismantle a medical-necessity denial by quoting Cigna's own SPD definition.
BCBS denial appeals: navigating the state federationUntangles BCBS as a 33-member federation; how to identify your specific plan from the EOB header and ID alpha prefix; BlueCard out-of-state routing; when to escalate to state DOI.
Kaiser Permanente denials — navigating an integrated planCovers why Kaiser's integrated payer-provider model makes internal appeals structurally limited and positions California's DMHC Independent Medical Review (IMR) as the strongest external path.
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