Costs & Insurance

What to Do When Insurance Denies a Claim

About this guide

Written by: My Medical Choice Editorial Team

This guide is designed to help patients and families prepare for better conversations with licensed healthcare professionals. It is general educational information only and is not medical advice.

This article is for general educational purposes only and is not medical advice. Talk with a qualified healthcare professional about your personal health situation.

An insurance denial does not always mean the answer is final. It may mean more information, prior authorization, coding clarification, or an appeal is needed.

Steps to consider

  • Read the denial letter carefully.
  • Note the reason, deadline, and appeal instructions.
  • Call your insurer and ask what information is missing.
  • Ask the provider’s office whether they can submit additional documentation.
  • Keep records of calls, dates, names, and reference numbers.
  • Submit appeals before the deadline.

For complex situations, ask your provider, employer benefits department, state insurance department, or a patient advocate where to get help.

Frequently asked questions

Does a denial mean the decision is final?

Not always. It may mean more documentation, coding clarification, prior authorization, or an appeal is needed.

What should I check first?

Read the denial letter, note the reason and appeal deadline, and call the insurer to ask what information is missing.

Who can help with an appeal?

Your provider’s office, employer benefits department, insurer, state insurance department, or a patient advocate may be able to help.