Get the decision in writing

Ask for the exact denial reason, reason code, plan provision, and clinical criteria used. If the explanation on the phone differs from the written notice, ask which one controls and how the record will be corrected.

Name the next review path

Ask whether the next step is a correction, reconsideration, peer-to-peer review, internal appeal, or external review. These paths are not interchangeable.

  • Who can submit the next request?
  • What evidence is required?
  • What is the exact filing deadline?

Leave with a reference

Capture the representative’s name, call reference number, any promised action, and the date you should expect a response.

Use this to prepare—not to replace the plan.

Your plan documents, written notices, and applicable law govern your situation. If a deadline or benefit is unclear, ask the insurer to identify the controlling document in writing.