What Is a Concurrent Review Denial?

A concurrent review denial occurs when your insurance cuts off coverage for treatment that has already begun — such as ending hospital stay coverage before your doctor says you're ready for discharge.

How Concurrent Review Works

While you're receiving ongoing treatment (hospital stay, rehab, skilled nursing), your insurer periodically reviews whether continued care is medically necessary. If they determine it's not, they issue a denial for continued stay.

Common Concurrent Review Denials

  • Hospital stay cut short (insurer says you can recover at home)
  • Rehabilitation days reduced
  • Skilled nursing facility stay denied after a certain point
  • Behavioral health/substance abuse treatment terminated early
  • Home health visits reduced

Your Rights

  • Advance notice: The insurer must notify you before terminating coverage
  • Continue treatment: In many cases, you can continue treatment during the appeal
  • Expedited review: Because you're currently receiving care, you qualify for expedited (72-hour) appeal
  • Physician involvement: Your treating doctor can request a peer-to-peer review

How to Appeal

  1. Act immediately — You typically have very limited time (24-72 hours)
  2. Request continuation of benefits during the appeal
  3. Have your doctor call for an urgent peer-to-peer review
  4. Submit clinical documentation showing continued medical necessity
  5. Request expedited external review if internal appeal is denied

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Frequently Asked Questions

Can they really discharge me while I'm still sick?

The insurer can stop paying, but they cannot physically discharge you. Your doctor makes the medical decision. However, you may become financially responsible. Appeal immediately and request continuation of benefits during the appeal.

Can I stay in the hospital during the appeal?

Under most plans, you can request continuation of benefits during an expedited appeal. This means coverage continues until the appeal decision is made. Talk to the hospital's case manager or patient advocate.

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