Insurance claim ... denied
On the other hand, a denied claim has been processed, and your insurance provider has decided it won't pay. "They're saying, 'We're not paying this claim. Ever,'" Moaratty says. "They have determined you do not have the benefit."
But don't pay yet. Someone could have entered information incorrectly or failed to provide enough information. "There are lots of changes in the coding industry," she says. For example, some procedures are required to be bundled under one code and then paid, she says. If the medical office submits some of the procedures separately, then a claim could get denied or partially denied. Perhaps a patient has colon cancer as well as diabetes, she says. Treating the colon cancer might be different for a diabetic patient, but unless the paperwork is coded properly, the claim might be denied.
If the claim is denied, you have the right to appeal, she says. And if you're overwhelmed with the illness and the paperwork, find someone who can help you.
Takeaway: Don't pay a denied medical claim yet. Appeal it and ask for help if needed.