claim denial

A claim denial occurs when an insurance company refuses to cover a medical expense or service you've requested. This typically happens if the claim doesn’t meet the insurer’s guidelines, such as lacking necessary documentation, being outside the policy’s coverage, or if the treatment isn’t deemed medically necessary. When a claim is denied, you usually receive an explanation from the insurer detailing the reason. Understanding the reason allows you to review your options, which may include appealing the decision or correcting any issues to resubmit the claim.