Got an Insurance Denial for Therapy? Here’s Your First Move

Opening a letter that says your child’s therapy has been denied is gut-wrenching. But a denial is often just the first round, not the final word. Here’s how to respond.

1. Read the reason carefully

Denials come with a stated reason: “not medically necessary,” “insufficient documentation,” “annual limit reached,” and so on. The reason determines your strategy. “Insufficient documentation” is very different from “not a covered benefit.”

2. Note the appeal deadline immediately

You typically have a limited window — often around 30 days — to file an appeal. This is the single most important date to capture. Miss it, and you may have to start over. Write it down the moment you read the denial.

3. Build your case with evidence you already have

A strong medical-necessity appeal pulls together your child’s diagnosis, the prescribing provider’s recommendation, therapy progress notes, and behavior data showing why the service matters. If you’ve been logging sessions and behaviors, you’re already halfway there.

4. Consider having it reviewed

For complex denials, a patient advocate or attorney who specializes in this can dramatically improve your odds. An appeal letter is a starting point — having a professional review it before submission is worth it when the stakes are high.

Denials are common, and they’re frequently overturned. Don’t let the first “no” be the last word for your child.