Phrases Patients Hear, but Rarely Get Explained 

1. “You don’t meet criteria” - This means the insurance plan or system has specific rules for coverage, and based on their standards, they believe those requirements were not met.

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2. “Not medically necessary”- This means the insurer has decided the service does not meet their definition of what is required to diagnose or treat a condition, even if a doctor recommends it.

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3. “Out of scope”- This means the service or request falls outside what a particular provider, program, or insurance plan is responsible for covering.

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4. “Experimental treatment”- This means the treatment is considered new, unproven, or not yet widely accepted under the insurer’s coverage rules.

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5. “Pending review”- This means a decision has not been made yet and the request is still being evaluated by the insurer or system.

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6. “Denied due to lack of documentation”- This means the insurer believes there was not enough supporting information provided to justify coverage.