Under ERISA and New York insurance law, every denial entitles you to a written explanation, a copy of the policy language being relied on, and at least one level of internal appeal — usually within 180 days of denial.

Insurers cannot deny coverage simply because they "disagree" with your doctor. Denials based on medical necessity must be reviewed by a same-specialty physician and supported by the policy's own medical-necessity definition.

If internal appeal fails, New York law and the Affordable Care Act give you the right to an independent external review by a neutral third party — and external reviewers reverse insurer denials at very high rates.

A statute-citing, fact-organized appeal forces the insurer to engage on the merits. Generic appeals get denied; appeals that quote the policy language, cite the applicable statute, and attach physician documentation routinely get reversed in Brooklyn and across New York.