What is an Insurance Claim Denial?
Have you ever gone to the doctor, submitted your claim, and got a letter saying your insurance won’t pay? That is a denial. It means your insurer has rejected the claim, either for a service they say isn’t covered or for some other reason. It doesn’t always mean you’re stuck with the bill, but it does mean […]
Hospital Financial Assistance Programs
Hospital financial assistance programs may reduce or eliminate a medical bill, even when you have insurance and your claim has been denied. A denial can leave you staring at a balance you never expected to pay. The hospital may suggest monthly payments or a medical credit card, but accepting either option too quickly could make […]
The Most Common Reasons for Denied Medical Bill Claims
Why do claims get denied? The most common reasons include missing information, incorrect billing codes, lack of pre-authorization, or service being out of network. Sometimes, the insurer simply doesn’t believe the service was medically necessary. Knowing these reasons can help you spot errors and avoid denials before they even happen. Please call me. I’m here to […]
Out of Network Air Ambulance Services
The No Surprises Act prevents surprise bills for emergency services, even if received from an out-of-network provider or facility. It limits out-of-network cost-sharing for non-emergency services received at an in-network facility, such as hospitals or ambulatory surgical centers. It also prohibits balance billing for air ambulance services, even if they are out-of-network. Please call me. I’m here […]
Setting Up Payment Plans for Denied Medical Bills
Setting up payment plans may protect your monthly budget, but agreeing too quickly can leave you paying a medical bill that should have been corrected, reduced, or covered by insurance. A denied claim can create immediate pressure. The provider wants payment, collection notices may be approaching, and a monthly arrangement can feel like the safest […]
A $54,000 Medical Bill Written Off After Denial
When a provider considers your procedure to be necessary and the insurance company says, “Hey, it wasn’t medically necessary,” you have to fight to make sure that the insurer does not pass the cost to you. If you can prove that it was medically necessary, your denied claim should be paid. I recently had a case where […]
Confused by Insurance Jargon
Denial letters are full of insurance jargon, but don’t let that intimidate you. Look for the reason for the denial. It’s usually listed by a code. And check your explanation of benefits, your EOB, it’s called. You have to understand the exact reason, which will help you determine your next steps, whether it’s correcting an error, appealing a […]
Cash Pay vs Insurance Pricing After a Claim Denial
Cash pay vs insurance pricing can create a startling result: the price for using health insurance may be higher than the amount offered to someone paying without insurance. That difference becomes especially painful when your claim is denied and the provider suddenly expects you to pay the full balance. Before paying, switching to cash pricing, […]
Getting Denied Is Not the End
Getting denied isn’t the end of the road. You have the right to appeal. That means asking the insurer to reconsider the decision. Start by calling the insurer to understand the denial. Then submit an appeal, usually in writing, with all the supporting documents. Be polite, clear, and timely. You would be surprised how many denials are overturned. […]
Why You Always Want a Pre Approval Letter
Many services require pre-authorization from your insurance company. That means your doctor has to get approval before doing a test or procedure. If that doesn’t happen, your claim could be denied, even if you really needed that care. Always ask if your service needs pre-approval to avoid unexpected bills. I recommend you get the approval in writing from your […]