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3 Ways to Avoid Denials

claim denialIt’s denial season! A denial is a confirmation from a health insurance company that payment will not be made for a particular service or visit. Basically, you are paying most, if not all of the cost. If you used your health insurance already this year, you are at risk.

The Facts

To start, cold and flu season peaks around January and February, it is highly probable by now you have visited your physician. If you went to the doctor, likely the costs for services have been sent to the health insurance company for processing. The insurance companies are required to make a decision on payment within 30 days. Then a notification is sent to your doctor and you. Only a portion of the costs are paid by the insurance company, the rest is your responsibility. However, sometimes the insurance company pays nothing either for the whole bill or a portion.

If this happened to you, check your notification. A mistake could easily have been made that requires correction. Don’t pay more than necessary, healthcare costs can add up quickly. Medical bills are the leading cause of debt in the U.S., which can be avoided. When you go out to eat, you don’t let the waiter overcharge you. Why would you let your insurance company?

Common Costly Mistakes

Did your health insurance notification mention your doctor was out-of-network?

Was your doctor part of your insurance’s network, meaning was the provider listed on your online provider   directory? If so, this is a processing mistake! You should not receive a denial (non-payment) when your doctor is in-network.

Did you receive a preventative service?

Preventative services should be provided at no cost to you. Yes, we mean $0. If you were billed for these services, it’s a mistake. Don’t overpay for services.

During your doctor’s visit, did you get a test or lab service?

Your doctor MUST send your tests and labs to other In-network providers. It’s in their contract with any health insurance company, which means you pay less. If you received a considerable high bill for a test or lab service, better check your doctor sent to the right place. Don’t get cheated out of lower rates.


The best way to ensure you are paying correctly is to check all the paperwork sent from your insurance company and your physician. If something seems odd, speak up. It is the only guarantee to avoid being overcharged. In our next post, we will discuss all the denial issues with emergency services. A must read checklist to stop you from getting billed in full.

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