What if my plan says the medication is not covered?

If your medication is not on your plan's formulary, Appealio pivots to a formulary exception strategy, building the case for why this specific medication is medically necessary for you, referencing your plan's own coverage criteria and clinical evidence.

Does Appealio submit the appeal for me?

Yes. After building your appeal packet, Appealio handles submission directly to your insurer via fax or mail, tracks the deadline, and follows up weekly to ensure your case is being reviewed.

What if I already appealed once and was denied?

If your first appeal was denied, you typically have the right to a second-level appeal or external review. Appealio can help with escalated appeals. Often a second appeal with stronger evidence and better legal framing succeeds.

How long does the appeal process take?

Most insurers must respond to standard appeals within 30 days and expedited appeals within 72 hours. Appealio tracks these deadlines and escalates if your plan misses them.

What if my plan requires step therapy first?

Appealio files step therapy exceptions by documenting medical reasons why cheaper medications are inappropriate for you, such as prior failures, contraindications, or documented adverse reactions.

What if my plan says the medication is not covered?

If your medication is not on your plan's formulary, we pivot to a formulary exception strategy. We build the case for why this specific medication is medically necessary for you, referencing your plan's own coverage criteria and clinical evidence. Many denials are overturned when the right arguments are made.

Do you submit the appeal for me?

Yes. After we build your appeal packet, we handle the submission directly to your insurer and track the status in real time. We also monitor the deadline and follow up to ensure your case is being reviewed. You stay informed without having to chase the insurance company.

What if I already appealed once?

If your first appeal was denied, you typically have the right to a second-level appeal or external review. We can help with these escalated appeals as well. Often, a second appeal with stronger evidence and better legal framing succeeds where the first one did not.

How long does the appeal take?

Most insurers are required to respond to standard appeals within 30 days and expedited appeals within 72 hours. We track these deadlines and escalate if your plan misses them. If the internal appeal is denied, we can help with external review, which typically takes 60 days.

What if I am being forced to switch medications?

Forced switches happen when insurers try to move you to a preferred alternative. We fight these by documenting why your current medication is medically necessary and why switching would be harmful. This often involves showing a history of effectiveness, prior failures with alternatives, or unique clinical reasons your doctor prescribed this specific drug.

What if my plan requires step therapy first?

Step therapy means you must try cheaper medications before your plan covers the one your doctor prescribed. We file for step therapy exceptions by documenting medical reasons why those cheaper drugs are inappropriate for you, such as prior failures, contraindications, or documented adverse reactions.

What documents or details do you need from me?

You will need your denial letter, insurance card, and basic medical history related to the medication. We guide you through uploading these documents during the intake process. If you are missing anything, we help you request it from your doctor or insurance company.

Medication Coverage

Denied Medication?
Keep your treatment on track.

When insurance says no, we build the case and run the appeal. Upload your denial, answer a few questions, and we handle the rest.

Step TherapyFormulary ExceptionContinuation

We submit + follow up for you

Monthly Cost

Denied

$1,200

Out-of-Pocket

Covered

$25

Standard Copay

Common Denials

Why was your medication denied?

Insurers use specific codes and policies to say no. We know exactly how to counter each one.

Step Therapy / Fail First

Insurance wants you to try cheaper drugs before covering the one your doctor prescribed.

Prior Authorization Denied

Missing criteria, paperwork issues, or claims that the drug isn't 'medically necessary'.

Formulary Exclusion

The drug isn't on your plan's covered list. We pivot to a formulary exception strategy.

Forced Switch

Your insurer is forcing you to switch from a working medication to a preferred alternative.

Continuation Denied

They covered it before, but now they won't. We fight for stability and continuity of care.

Quantity / Dose Limits

Your doctor prescribed a specific dose or amount that the plan refuses to cover.

Not sure what your denial means?

Choose what resonates most with your situation:

Coverage Finder

Check if we cover your medication.

Search by medication name or health condition to see if we can help with your appeal.

Try searching for "Dupixent" or "Rheumatoid Arthritis"

Our Process

How Appealio helps you win.

1. Decode the denial

We analyze your letter to find the specific policy criteria they claim you didn't meet.

Policy Match

2. Collect evidence

We guide you to upload records like PT notes, symptom logs, and doctor's orders.

3. Write the argument

We draft a professional letter citing your plan's own clinical guidelines.

4. Submit & Track

We send your appeal directly to your insurer and track the status in real time.

Sent

Received

Tracked

The Deliverable

What's inside your appeal packet.

A comprehensive, professional submission designed to overturn the denial.

The Appealio Packet

Ready for submission

Legal & Clinical Argument

A clear, evidence-based letter tying your condition to the specific medical necessity criteria in your plan's policy documents.

Evidence Bundle

Medical records highlighted to prove you meet the requirements (e.g. "Step Therapy failed on 10/12/23 due to adverse reaction").

Supporting Documentation

We compile your medical records, letters of medical necessity, and other clinical proofs to support the case.

Our Expertise

Sophisticated strategies.

We don't just complain. We use specific regulatory frameworks to force a review.

Criteria-by-criteria rebuttal of the insurer's checklist.

Step-therapy exception framing (documenting failures & intolerance).

Continuation-of-therapy logic to prevent treatment gaps.

Formulary exception pathways for 'not covered' drugs.

Federal parity law arguments for mental health meds.

Deadline management and automatic escalation to external review.

Coverage Catalog

Conditions and medications we currently support.

Browse our complete coverage catalog by category, or search above to find your specific medication.

Conditions

Medications

227+

Coverage Combinations

Last updated: January 2026

Don't see your medication?

Coverage is expanding. If you don't see yours, request it and we'll take a look.

Provider Supported

Patient-led,
provider-supported.

Your doctor wants you to get this medication, but they are buried in paperwork. Appealio makes it easy for them to help you.

We do the heavy lifting

We draft the clinical arguments so your provider can easily support the appeal.

Parallel paths

If your clinic already filed an appeal, our patient-led appeal adds a second layer of pressure.

We track deadlines so you don't have to.

Correct Submission

Direct to Insurer

Active Follow-up

Weekly status checks

Escalation

Level 1 → Level 2 → External

Common Questions

Frequently asked questions.

Everything you need to know about medication denial appeals and how Appealio can help.

Get Started

Start your medication appeal.

Most people finish the intake in about 15 minutes. If you're missing documents, we'll help you find them.

15 min intake24-48hr draftWe submit for you

Denied Medication? Keep your treatment on track.

Why was your medication denied?

Step Therapy / Fail First

Prior Authorization Denied

Formulary Exclusion

Forced Switch

Continuation Denied

Quantity / Dose Limits

Not sure what your denial means?

"I don't understand the denial"

"My doctor says it should be covered"

"Insurance wants me to try something else"

"It's covered but unaffordable"

Check if we cover your medication.

How Appealio helps you win.

1. Decode the denial

2. Collect evidence

3. Write the argument

4. Submit & Track

What's inside your appeal packet.

The Appealio Packet

Legal & Clinical Argument

Evidence Bundle

Supporting Documentation

Sophisticated strategies.

Conditions and medications we currently support.

Ankylosing Spondylitis

Asthma

Atopic Dermatitis (Eczema)

Bullous Pemphigoid (BP)

Don't see your medication?

Patient-led, provider-supported.

We track deadlines so you don't have to.

Frequently asked questions.

What if my plan says the medication is not covered?

Do you submit the appeal for me?

What if I already appealed once?

How long does the appeal take?

What if I am being forced to switch medications?

What if my plan requires step therapy first?

What documents or details do you need from me?

Start your medication appeal.

Denied Medication?
Keep your treatment on track.

Patient-led,
provider-supported.