What if...?
Real situations that come up beyond a straightforward denial — pick yours for exactly what to do.
- Your drug plan didn't answer by its own deadline
- The Independent Review Entity is overdue
- Your case is below the dollar amount required for the next level
- This is where a human often helps
- You missed a filing deadline
- You have both Medicare and Medicaid
- A quality-of-care problem, not a coverage denial
- A complaint about the plan's conduct
- This drug can't be covered by Part D at all
- You may be owed a temporary transition supply
- The prescriber's office hasn't sent the supporting statement
- You need the medication before an appeal can be decided