Prior authorization denials are not final. 81% of appeals win* — but insurance companies count on you not knowing that. AuthFight handles your entire appeal — from letter to submission.
Your request for Semaglutide (Ozempic) has been denied. Code: CO-50 — Service not deemed medically necessary. Step therapy alternatives have not been exhausted.
The data behind the problem
Appeal overturn rate
Of prior auth denials that are appealed get fully or partially overturned — most patients never try.
Lost to PA inefficiencies
In administrative costs lost every year because of prior authorization rejections across the US.
Ever appeal
Of patients who are denied ever file an appeal — even though 81% of those who do, win.
PA requests in 2024
Prior authorization determinations were processed by Medicare Advantage insurers alone last year.
Sources: KFF 2024 · CAQH Index 2024 · CMS Medicare Advantage Data
The system is built to make you give up.
They send confusing letters. They use codes nobody understands. They count on your silence.
AuthFight exposes the game — and gives you the tools to beat it.
of in-network claims are denied
Millions of patients affected every year — most with a legitimate right to their care.
of patients never appeal
Not because they can't win — because nobody told them how.
of patients abandon treatment
After a denial, most patients simply go without the care their doctor prescribed.
Sources: KFF 2024 · AMA · Health Affairs
Answer 5 questions. We handle everything after that.
Upload a photo of your denial letter or enter your denial code manually. Got rejected at the pharmacy counter? We can start from there.
Step 01
Drop file here or browse
PDF, JPG, PNG up to 10MB
Create your account. Takes 5 minutes.
Meet your Fight Score.
Before we generate a single word of your appeal, AuthFight calculates your Fight Score — a real number based on your insurer's own CMS-reported data, your denial code's reversal history, and your case urgency.
The score tells you three things: your appeal deadline, the clinical evidence and regulatory appeal rights most relevant to your denial type, and whether you're entitled to request external independent review if your internal appeal is denied.
See your Fight Score →Your Fight Score
Ozempic · CO-50 · Denied May 20, 2026
Score breakdown
Everything included
Real win probability using your insurer's own federally mandated overturn data. Know your odds before filing a single page.
5-question intake. Professional, personalized letter ready for your doctor to review in minutes.
Translates any denial code into plain English. Know exactly what happened and why.
Deadline auto-set based on your insurer and denial type. Weekly reminders so you never miss your window.
We submit directly to your insurer on your behalf. No fax machines. No portals. Nothing on your end.
Internal appeal denied? We prepare your external independent review request — the decision is binding on your insurer.
Every feature works together, from denial to decision.
The playbook
Example scenario
The appeal pulls the plan's own published clinical policy and lines it up against the patient's chart — documented step-therapy failures, labs, and the prescriber's rationale — so the denial contradicts the insurer's own criteria.
Biologic / specialty drug denial
Sample score
78
✓ Plan's own policy cited back to them
Example scenario
Insurers are generally required to state the specific basis for a denial. When a letter says "does not meet clinical guidelines" without naming the guideline, the appeal targets that procedural defect directly.
Procedural-defect appeal
Sample score
74
✓ Missing required criteria = strong appeal
Example scenario
The appeal documents each prior therapy tried and failed, maps the prescription to its FDA-labeled indication, and attaches the clinical society guidelines the plan's reviewers use themselves.
Step-therapy / formulary denial
Sample score
71
✓ Prior failures + FDA labeling documented
Example scenario
Medicare Advantage members have federally defined appeal rights with strict insurer deadlines — and CMS data shows the large majority of appealed MA denials are overturned. The appeal is built to those federal standards.
Medicare Advantage appeal rights
Sample score
82
✓ Most appealed MA denials are overturned
Example scenario
Most patients don't know that after an internal appeal, they're entitled to a review by an independent third party the insurer doesn't control. AuthFight flags external review automatically and prepares the file for it.
Independent external review
Sample score
69
✓ A reviewer the insurer doesn't pick
Example scenario
For DME denials — CPAP devices, insulin pumps, mobility equipment — the appeal maps the treating physician's documentation point-by-point onto the plan's published coverage criteria, closing every gap the reviewer could cite.
Durable medical equipment denial
Sample score
76
✓ Coverage criteria matched line by line
The scenarios above are illustrative examples of common denial situations and how AuthFight approaches them — they are not customer testimonials or actual case results. Sample scores are examples of the Fight Score feature, not real cases. Individual results vary. AuthFight does not provide medical or legal advice or guarantee outcomes.
Questions
Cost depends on how you sign up. If you're referred by one of our partner pharmacies, there's no cost to you. If you sign up directly, a flat fee applies before we submit your appeal — you'll see the exact amount upfront.
We handle prior authorization denials for prescription medications, specialty drugs, medical procedures, imaging, infusions, and durable medical equipment — for commercial, employer-sponsored, Medicare Advantage, and Medicaid managed care plans.
Most appeals receive a decision within 3–15 business days. Urgent cases (where delay would seriously jeopardize your health) qualify for expedited review within 72 hours — we identify and flag these automatically.
Yes — we treat it that seriously. Your data is encrypted in transit and at rest, access is restricted and logged, and we never sell it. When we work with your pharmacy or provider, we operate as a HIPAA Business Associate under a signed BAA; when you sign up directly, we apply those same HIPAA-level safeguards and share your information only with your doctor and your insurer, at your direction.
Possibly not. Most plans allow internal appeals within 180 days of the denial notice, and external appeals can be filed even later in many states. Enter your denial and we'll tell you exactly where you stand.
If your internal appeal fails, you have the right to a free external review by an independent third party, and the reviewer's decision is binding on your insurer. We prepare and submit the escalation paperwork for you.
We follow up with your doctor by phone until we have a signature. This is one of the most important things we do — we don't leave your appeal waiting.
AuthFight is not a law firm and doesn't replace one — it's a self-help tool that prepares your appeal at your direction. Our AI drafts the letter from your answers and published clinical evidence, your own doctor — the one who prescribed your treatment — reviews and signs it, and we handle the submission logistics. If your situation raises legal questions beyond the appeal itself, consult a licensed attorney.
Most patients have a complete appeal ready in under 2 hours.