MRI denied by insurance — how to appeal

About MRI

MRI denials are common because the imaging is expensive and many insurers require prior authorization. Most appeals succeed when the appeal letter clearly documents the clinical indication, the conservative treatments already tried, and the specific findings that necessitate imaging. Citing the American College of Radiology Appropriateness Criteria for the indication can substantially strengthen medical-necessity appeals.

Common reasons MRI gets denied

• Prior authorization not obtained
• Insurer determined the imaging was not medically necessary
• Wrong CPT code submitted
• Imaging not preceded by required clinical workup (e.g., conservative treatment trial)

Evidence that helps overturn a MRI denial

• Provider letter explaining the clinical indication for MRI
• Documentation of conservative treatments attempted
• Symptoms and exam findings supporting need for imaging
• Professional-society imaging appropriateness criteria (ACR, NCCN)

Recommended approach

For most MRI denials, our triage will recommend the Strong Appeal ($249) tier. We prepare a professionally-structured appeal that addresses the specific denial reason, cites the relevant clinical evidence, and meets your insurer’s appeal-rights deadlines. Treatment cost exposure: typically $1,000–$4,000.

What to do next

1. Find your denial letter (or EOB) and check the appeal deadline.
2. Upload it to InsureDefense for a free triage — no payment required to see the assessment.
3. If you choose to proceed, you’ll receive a draft within 24 hours (12 hours for urgent cases).
4. Submit the appeal to your insurer using the fax / portal / mailing address we provide.
5. Track the insurer’s response using our 14/30/45-day follow-up reminders.

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