Real people. Real denials overturned. Real results.
I was managing a primary immunodeficiency for years with monthly Xolair® injections. My infections worsened. My doctor recommended Hizentra®, a weekly home infusion to help prevent serious infections. But insurance denied it—twice. I was terrified. I felt like I was running out of options. I pushed back again with stronger documentation and a clear explanation of why this treatment was necessary—and we finally won. Now I have access to the care I need to stay healthy. If you’re facing a denial, don’t give up. Appeals work. Your life is worth fighting for.
After multiple denials for my medication, including my prior authorization renewal and two levels of appeal, I felt completely defeated. I was out of options and nearly gave up. I gathered all the missing information and escalated my case to an external review. I just got the call: my appeal was APPROVED.It’s been a long, frustrating road, but I’m finally back on track. If you’re still fighting, hang in there. You are not alone—and it’s worth it.
I recently won an appeal after discovering that my insurance company miscalculated my max out-of-pocket. I had been paying bills thinking I hadn’t hit my limit, but something felt off—so I requested a detailed claims breakdown. Turns out, due to some reprocessed claims and billing delays, several payments weren’t counted toward my max out-of-pocket. After pointing this out and submitting an appeal, they re-reviewed everything. The result? Not only had I already hit my max, but I was also owed money for what I overpaid. The insurer issued a refund, and a few pending balances were wiped out. Always double-check those numbers—this one really paid off!
After an initial denial for Saxenda®, the case was escalated to an independent review. The reviewer disagreed with the original decision and overturned it. The request was officially approved for 6 months of treatment. This is a great reminder that even when a prior authorization is denied quickly, an independent review can reverse the outcome. If you believe your treatment is medically necessary, keep pushing and appeal—success is possible.
I scheduled a routine colonoscopy, thinking it would be fully covered under preventive care. But a month later, I got hit with a surprise copay. When I called my insurance, they said it was because a polyp was removed during the procedure. I knew that under the ACA, preventive colonoscopies—including polyp removal—shouldn’t come with a copay, so I filed an appeal. I included documentation showing it was a screening, not a diagnostic procedure. A few weeks later, I got the good news: appeal approved! The copay was removed, and I didn’t owe a cent. Moral of the story: know your rights when it comes to preventive care. Appealing is worth it!
My doctor ordered routine lab work during a visit and sent the samples off to the lab, like usual. A few months later, I got a hefty bill saying the claim was denied—apparently the lab was “out-of-network.” I was confused since I didn’t choose the lab—my doctor sent it as part of in-network, plan-directed care. So I filed an appeal explaining that I followed my plan’s rules, and had no control over where the labs were processed. Good news: the appeal was approved! The charges were reprocessed at the in-network rate and I owed almost nothing. Always appeal when it doesn’t make sense—just because they deny it doesn’t mean they’re right.