Exception Request

An exception request is a formal appeal made by a policyholder or healthcare provider to an insurance company seeking coverage for a service or treatment that is not typically covered under the terms of the insurance policy. Exception requests are typically made when a healthcare provider believes that a particular treatment is medically necessary for the patient’s condition but may not be included in the standard coverage. The insurance company will review the request and determine whether to approve or deny coverage based on medical necessity and policy guidelines.