Reviews & appeals

In the pages linked below, you’ll find detailed instructions on how to ask us to reconsider a decision we’ve made, whether coverage and payment or authorizations denials. For pharmacy requests or drug authorization appeals, visit our drug information page. 

Claim reviews & appeals

Use the instructions on the pages below to submit reviews and appeals requests for medical and behavioral health claims.

Note: An informal claim review decision is required to process an appeal.

Authorization appeals

Use the instructions on the pages below to submit appeals for denied medical and behavioral health authorizations.

Note: If you have a denied outpatient, home health, DME, elective inpatient or behavioral health authorization on file, submit an authorization appeal before performing the service – not a post-claim review request. Effective June 2, 2025, we won't review these cases for medical necessity post-claim if a denied authorization is on file.