A claim denial occurs when an insurer decides not to pay all or part of a submitted insurance claim. A denial does not always mean the service is permanently ineligible for reimbursement: the reason may be missing information, an eligibility issue, a filing deadline, a coding or documentation problem, or a plan limitation.
The first step is to review the insurer’s explanation of the denial and identify the specific reason. Depending on the situation, the next step may be to correct and resubmit the claim, provide additional documentation, request reconsideration, or appeal under the plan’s rules. Therapists should track deadlines and retain copies of claim details and communications.