What to do after a prior authorization denial

Questions to ask after a denial

1. Keep the denial notice

   Save the full notice for your own records. Note which service or item it concerns and the reason stated in the notice. You do not need to share the notice with Nivellark.

2. Ask the plan to explain its decision

   Use the plan’s contact information to ask what reason it applied, which plan document or criteria it considered, and what information it reviewed. You can also ask how to obtain any records relevant to the decision.

3. Confirm which next steps apply to your coverage

   Ask whether a review or appeal is available for this decision, how and where to request it, whether any deadline applies, and whether a faster review can be requested if timing could affect care. Ask the plan to point you to instructions for your plan and state; do not rely on a general timeline.

4. Talk with the clinician who made the request

   Share the reason in the notice with your clinician. Ask whether they can explain the request, address the reason the plan gave, or send additional information if appropriate.

5. Keep a private follow-up record

   For your own reference, note when you contacted the plan or clinician, whom you spoke with, what they said, and any confirmation number or next step they provided.