About Insurance Denials
An insurance denial occurs when an insurance company does not approve your surgical procedure or decides to deny payment for a procedure you have already had. Simply put, the insurance company is saying it will not pay for a specific procedure, surgery, test, medication, or treatment.
An insurance denial can occur for many reasons. (See Why Insurers Deny.) As a patient, you may think that an insurance denial is final, but that is not the case! As a member of an insurance plan, you have the right to appeal decisions made by the insurance company when it denies coverage or payment for a medical procedure or treatment.
Why appeal an insurance denial?
The truth is that insurance companies routinely deny coverage for a wide range of procedures and treatments because they know the vast majority of patients will become discouraged and not fight the denial further. According to one study, healthcare insurers deny almost one out of every five claims, and less than 1% of those denied claims are appealed.
Appealing an insurance denial can be a complicated, confusing, and time-consuming process, but PRIA Appeals can help. If you receive an insurance denial, contact us for a free assessment of your case. We work with all insurance companies. An insurance appeal may get you the coverage you need!