You are here

What To Do If Your Claim Is Denied

1. Compare your medical bill to you insurance explanation of benefits (EOB). Make sure the same care item is listed on each piece of paper so that you were not wrongfully billed and denied for care that did not occur. 

2. If the medical bill and EOB match, ask your doctor's billing staff if there is any way they could re-submit the bill with a different diagnosis code that would help get your medical care covered. 

3. Call the medical provider billing department and ask for their cash price for the medical care item received. This is now your target payment. You can even ask to make bill payments over several months or a year. 

4. Call your insurance company and ask what you would have to pay for that care item if you did not yet meet your deductible and had to pay out-of-pocket for the medical care item if it was to be a covered service. Never pay more than this amount to settle the claim. 

5. Never pay the charge amount, aka retail rate. Always ask for the first and last name and title of the person you are speaking to in order to promote accountability and a desired level of customer service. Be nice. You get more bees with honey than with vinegar. Good luck! You can do it. Knowledge is power and you are now powerful.