When A Claim Is Denied

Here are a few tips to follow if you get billed for a medical, dental, or vision service that you thought was covered by your plan.

Create A Paper Trail

Before you act, have all your claim documentation:

  • Copies of claim denial letters and your explanation of benefits
  • Any correspondence between you and your health care provider (doctor, hospital, or lab), as well as any correspondence between your health care provider and your medical plan
  • Detailed notes of any phone conversations with your plan provider

Know Your Plan Rules

Your medical plan has a formal process for resolving disputes about denied claims. Read your plan rules to learn the specifics about your plan’s process. Contact your medical plan’s claims department with any questions. Summary plan descriptions are available on the U.S. Benefits Enrollment Site.