Cancer treatment denials
Oncology denials are often the most urgent — both medically and financially. Carriers sometimes deny first-line chemotherapy, immunotherapy, off-label uses, and proton therapy. Most reverse on appeal when the oncologist's documentation is filed correctly.
What gets denied
- Off-label chemotherapy or immunotherapy
- Proton beam therapy
- CAR-T cell therapy
- Genetic and biomarker testing
- Second-opinion consultations at NCI centers
- Compassionate-use drug coverage
Common denial reasons
- Treatment deemed 'experimental' or 'investigational'
- Off-label use not in NCCN compendium
- Site of care (proton facility, NCI center) not in network
- Genetic test not justified by family history
How we approach the appeal
Cite the NCCN, ASCO, and other oncology compendiums. Attach the oncologist's full pathology and staging report. Request expedited review on grounds of imminent risk to health. Many plans honor compassionate-use carve-outs once formally requested.
Urgent: 72 hours. Standard: 30 days. Compassionate-use requests are often resolved in days.
$10,000 – $500,000+
- · Denial letter
- · Oncologist's treatment plan
- · Pathology and staging report
- · Prior treatment summary
- · Genetic / biomarker test results (if applicable)
Got a cancer denial?
Free 24-hour review. Send the denial letter and we'll tell you whether your case has a shot and what the next step would look like.
Start my appealThis page provides general information about appeal strategy. It is not legal advice. Outcomes depend on documentation, plan terms, and timing.