Site of Care Denials: Approved Drug, Wrong Location. How to Appeal.

Your insurance approved your infusion medication. Your doctor wants to administer it in their office, where you have been going for years. But your insurance company says no – they want you to go to a hospital outpatient facility instead. Or maybe it is the reverse: your insurance will cover your injection at your doctor's office but not at the hospital infusion center where your oncologist wants to monitor you closely.

This is called a site of care denial, and it is one of the most frustrating types of coverage barriers because the medication itself is not in question. Your insurance company has agreed that you need the drug. They just disagree with your doctor about where you should receive it.

Site of care denials have become increasingly common as insurers look for ways to control costs by steering patients toward lower-cost settings. Understanding why these denials happen, what your rights are, and how to appeal them can help you get your treatment in the setting that makes the most sense for your situation.

Ellen can help you appeal site of care denials and document why your preferred location is medically necessary. Start here →