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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.
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Rule status (mixed route): Status, 2026-10-03: public prior-authorisation metrics reporting began 2026-03-31 for impacted payers; HHS OIG found 13% of Medicare Advantage prior-authorisation and 18% of payment denials met coverage rules, with most appealed prior-auth denials overturned.
Automated decision this documents: payer prior-authorisation denial behaviour
Free path, in order (no cost):
The plan's own published prior-authorisation metrics page
SHIP or your state's free insurance counselling service
Medicare's plan-finder and complaint routes
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.
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