All guides · Procedure & treatment guides
Procedure & treatment guides
Appeal blueprints for specific treatments — imaging, surgery, fertility, behavioral health, specialty drugs.
GLP-1 medication denials are the most common specialty-drug appeal we see. The denial reasons cluster around a handful of patterns; the appeal evidence is usually similar.
MRI denied by insurance — the full appeal guideHow to use the ACR Appropriateness Criteria, clinical history (symptom duration, exam findings, prior workup), and the plan's medical-necessity language to win an MRI appeal.
Bariatric surgery denied — your appeal optionsA criterion-by-criterion walkthrough of bariatric appeals — BMI thresholds, 6-month supervised programs, co-morbidities, psych eval, sleeve vs. bypass, and plan exclusions.
IVF and fertility denial appeals — what your state allowsHow state IVF mandates (NJ, NY, IL, MA, RI, CT, CO and others) interact with ERISA preemption for self-funded plans, plus the clinical evidence that wins fertility appeals.
Mental health therapy denied — using the Parity ActIdentifying parity violations (session caps, prior-auth disparity, NQTLs, network adequacy) in therapy denials and invoking MHPAEA plus the 2024 final-rule comparative-analysis requirement.
TMS denied — the appeal blueprint for treatment-resistant depressionThe chart-level documentation that makes TMS appeals win: drug-class diversity, therapeutic doses, adequate trial durations, PHQ-9 thresholds, and FDA/APA citations.
Mental Health Parity Act: using it in your appealMHPAEA and the 2020 CAA require parity; this guide shows how to identify a parity violation in a denial (session caps, MH-only prior-auth, narrower medical-necessity rules, network gaps) and how to frame it in an internal appeal or state DOI / DOL complaint.
InsureDefense is not a law firm, insurer, medical provider, or claims adjuster. We do not provide legal, medical, or insurance advice. We prepare appeal documents based on the information you provide. We do not guarantee approval, payment, coverage, or reimbursement. For urgent medical situations, contact your doctor, insurer, or emergency services directly.