Last updated: July 7, 2026
Prior Authorization Denied? Here's Exactly What To Do Next
A prior authorization denial feels overwhelming, but you have clear legal rights and a structured process to fight it. Here's exactly what to do — today, this week, and beyond.
First, Read Your Denial Letter Carefully
Before you do anything else, locate your denial letter (it may be a physical letter, an email, or a notice in your insurer's online portal) and find these three things:
Find the Specific Denial Reason Code
Your denial letter must include a specific reason for the denial. This could be "not medically necessary," "experimental/investigational," "out-of-network," or a specific policy exclusion. Write down the exact language — you'll need it for your appeal.
Find Your Appeal Deadline
This is the single most important date on your denial letter. Missing it can forfeit your appeal rights entirely. For a full breakdown of deadlines by claim type, see our appeal response timeline guide.
Find the Appeals Mailing Address or Portal
The denial letter should tell you exactly where to send your appeal. Some insurers accept appeals online through their member portal; others require mailed documents.
Your Legal Rights Under the 2026 CMS Rule
The CMS Interoperability and Prior Authorization Final Rule, taking effect in 2026, establishes new requirements for health plans:
- 7-day standard response — Plans must respond to standard prior authorization requests within 7 calendar days
- 72-hour urgent response — Plans must respond to urgent requests within 72 hours
- Specific denial reasons — Plans must provide a specific reason for any denial, not a generic response
Step-by-Step: What to Do Today
Call Your Doctor's Office
Your doctor's office may be able to resubmit the prior authorization with additional clinical documentation. In many cases, the denial was caused by incomplete information rather than a genuine clinical disagreement.
Request a Peer-to-Peer Review
Your treating physician can request a peer-to-peer review — a direct conversation with the insurer's medical director who made the denial decision. This is often the fastest way to overturn a prior authorization denial and can sometimes be resolved in a single phone call.
Start Your Written Appeal Immediately
Don't wait for the peer-to-peer review to start your written appeal. You can always withdraw the appeal if the peer-to-peer resolves the issue, but you can't get back time lost if it doesn't. Learn how to write an effective appeal letter.
What to Do If It's Urgent or an Emergency
If your situation is urgent — meaning a standard timeline could seriously jeopardize your life, health, or ability to regain maximum function — you have the right to request an expedited appeal. Under federal law, insurers must make a decision on expedited appeals within 72 hours.
To request an expedited appeal, call your insurer's member services number and explicitly ask for an "expedited" or "urgent" appeal. Your treating physician may also request this on your behalf.
If Your Appeal Is Denied Again
External Review Rights
If your internal appeal is denied, you have the right to an external review — an independent third party (not your insurer) reviews your case. Under the ACA's external review process, the external reviewer's decision is generally binding on the insurer.
Skip the Research — Let AI Build Your Appeal
ApproveIt reads your denial letter and generates a professional appeal citing the exact clinical guidelines your insurer follows. Free to try — 15% fee only if your appeal wins.