What Should You Ask After a Coverage Denial for Private Rehab in California?
Do not treat a verbal statement such as “not covered” or “not medically necessary” as the full explanation. Ask whether the decision concerns eligibility, an excluded benefit, prior authorization, the requested level of care, the facility, timing, missing documentation, or another contract term. Request the exact language in writing, along with the name of the insurer or plan administrator that made the decision. A denial is not proof that care is unnecessary, but it also does not establish that a particular facility or service is appropriate.
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