Health Agent · Prior authorization
Find out what your prior-auth request is missing — before the plan does.
A prior-authorization denial almost always comes down to one thing: the plan wanted a specific piece of evidence and it wasn't in the file. Pick the reason the plan gave, check off what you already have, and this page names exactly what's still needed to overturn it — and how long the plan has to decide.
Readiness checker
Pick the reason. Check what you have. See the gap.
Result
In one line
The whole check runs in the page you already loaded — no upload, no account, no server call. Health Agent never sees the medication, the diagnosis, or the patient. See the proof →
How it works
An evidence checklist, not a black box
Each prior-authorization denial reason has a known set of evidence that overturns it. Step therapy is overturned by proof the required first-line drugs were already tried and failed. "Not medically necessary" is overturned by the diagnosis on record plus objective evidence of severity. This page holds that map for the eight most common reasons and shows you which pieces are present and which are still missing — so the request goes in complete the first time.
It does not diagnose, it does not decide coverage, and it never submits anything. It is a readiness checklist and a drafting aid. The clinical case is the prescriber's; the coverage decision is the plan's.
After you close the gap
Once the evidence is in hand
When the required items are checked off, the next step is the request itself, and — if it's already been denied — the appeal. The local appeal desk drafts the letter on your own computer so records never leave your hardware; the deadline checker tells you how long you have to file. Prior authorization appeals run on the same ladder as any other coverage denial.
Questions
Common questions
Does anything I pick get sent anywhere?
No. The check is computed by code already running in your browser. There is no server endpoint behind this page — your selections never travel over the network and are not stored. Close the tab and nothing is kept.
Where do the evidence checklists come from?
From the documentation payers commonly require to overturn each denial reason — failed step-therapy trials, contraindications, the diagnosis on record, objective severity evidence, compendia or FDA status for off-label and investigational denials, and so on. They are a starting map, not a guarantee; your plan's exact criteria are in the denial notice.
How long does the plan have to decide?
For Medicare Advantage, a standard organization determination is due within 14 calendar days and an expedited one within 72 hours (42 CFR §422.568 / §422.570). For Part D, a coverage determination is 72 hours standard / 24 hours expedited (42 CFR §423.568). Commercial and Medicaid windows vary by plan and state — this page says so rather than guessing a number.
Is this medical or legal advice?
No. It is a paperwork-readiness and drafting aid. It does not diagnose, adjudicate coverage, submit requests, or guarantee approval. Clinical decisions are the treating physician's. Confirm timeframes and criteria with the plan and at medicare.gov.