Published
Every denial letter has two deadlines. Most families only see one.
A denial arrives — nursing hours cut, a therapy ended, equipment refused. There are two clocks running, and the shorter one is the one that decides whether your child keeps receiving care while you fight.
The one everybody sees
The appeal deadline. Usually 60 days or less. Circle it in red.
The one that matters more
Continuation of benefits. Often as short as 10 days. If your child is currently receiving the service and you request continuation in writing inside that window, care continues while the appeal runs. Miss it and services stop on the effective date, even though you appealed on time.
Make them name the criterion
"Not medically necessary" is a conclusion, not a reason. Ask the plan to cite the specific policy criterion they found unmet. Then get a letter of medical necessity from the prescribing physician that answers that criterion, in that language. A generic letter about how much your child benefits will lose; a letter that addresses the cited standard often wins.
And keep going
Plan appeal, then Medicaid Fair Hearing, then the Subscriber Assistance Program. Families win at these levels regularly. The system relies on people giving up at step one.
One habit worth building: after any call that matters, ask for a reference number and email yourself one line — date, name, what they said. That note wins appeals two years later.