Claim Denied? Don’t Panic — Do This
A denial letter is the start of a process, not the end of one. Here are the exact first steps.
I’m Christopher Horne, a licensed health insurance broker serving Florida, Texas, Arizona, Ohio, Michigan, Iowa, North Carolina, Oklahoma, Missouri, South Carolina, Tennessee, Kansas, Louisiana, Maryland, Mississippi, Virginia. The letter says “denied” and your stomach drops. I’ve talked a lot of clients off that ledge. Most denials I see are fixable — wrong code, missing paperwork, a referral nobody sent. Work the steps.
Step 1: Read the Denial Letter (and the EOB)
Your carrier sends a letter and an Explanation of Benefits (EOB) — that’s the statement showing what was billed, what was paid, and why the rest wasn’t. Look for the denial reason in plain words: “not medically necessary,” “missing prior authorization,” “coding error,” “not a covered benefit.” The reason tells you the fix. Note the date on the letter — your appeal clock runs from it.
Step 2: Call the Number on the Back of Your Card
Call member services — the number printed on your card, not a random number from the internet. Ask, in this order:
- “Why exactly was this denied?”
- “What would need to change for it to be covered — a corrected claim, records, an authorization?”
- “What is my deadline to appeal, and how do I file it?”
Write down the date, the representative’s name, and the reference number for the call. If a bill collector calls before this is sorted, tell them the claim is under review — don’t pay a denied bill out of panic.
Step 3: Loop in the Provider’s Billing Office
A large share of denials are the provider’s coding or paperwork, and their billing office can often fix and resubmit them. Call, tell them what the carrier said, and ask them to resubmit correctly. Get a name there too.
Step 4: Appeal if the Answer Is Still No
Every plan has an appeal process and a deadline — the letter states both. An appeal is simply a written “please look again,” ideally with supporting records from your doctor. If your appeal is denied, most states and the federal Marketplace offer an external review by an independent reviewer. Don’t guess at any of this alone if the amount is real money.
This Is Where I Come In
Text me a description of the denial (not photos of documents) at 954-787-9118. I’ll help you read the letter, figure out which step you’re on, and what to say on the call. I can’t override a carrier — nobody can promise that — but I can make sure you don’t lose on a paperwork error.
Denial Letter Sitting on Your Counter?
Text me and we’ll go through it line by line. Don’t ignore it — deadlines run whether you open the envelope or not.
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