The Denial Says 'Not Medically Necessary'. Ask Which Rule That Means
Build a claim-denial criteria request It runs locally in this browser and sends nothing.
LIMIT FIRST: This is a preparation aid, not medical, legal or insurance advice. It cannot force a payer to pay, guarantee an appeal outcome, or tell you which care is right for you.
FREE TIER1 Free Run AvailableFree preview — Pro locked
Cost and free path
Cost: Free: one complete run in this browser, no account. Optional $4 one-time unlock allows unlimited runs of this tool on this browser. The free path and safety guidance never require payment.
Rule status (mixed route): Status, 2026-10-03: specific-reason and criteria requirements are operative for impacted plans; HHS OIG found denial explanations frequently failed to meet coverage rules, which is the gap this written request is aimed at.
Automated decision this documents: automated claim adjudication and medical-necessity criteria
Free path, in order (no cost):
The plan's appeals address on the denial letter — filing is free
Your state insurance department consumer service
A legal-aid health unit or patient advocate through LawHelp.org
What this cannot do: It cannot force a payer to pay, guarantee an appeal outcome, or tell you which care is right for you.
Sources checked 2026-10-03 · source bank reviewed against the live pages listed in metadata.
One-time payment. No subscription. Unlocks this tool on this browser only; not synced to other devices. Free use remains available. Safety information never requires payment. Client-side unlock is not purchase-verified. Refunds.
This tool reduces uncertainty; it does not replace a bank's fraud department, a mental-health professional, legal advice, a school privacy contact, or qualified technical help, and it cannot prove that a call, message, account, decision, or AI system is safe.
Convenience tier: unlimited runs on this browser$4 one-time