What is a Claim Denial?

A claim denial occurs when your insurance company refuses to pay for a healthcare service, procedure, or medication. The denial notice, called an Explanation of Benefits (EOB), includes specific reasons for the refusal and information about your right to appeal the decision. Common reasons for denials include services not covered by your plan, lack of prior authorization, coding errors, or services deemed not medically necessary.

Why claim denials matter

• Affects your finances: Denied claims may leave you responsible for the full cost of medical services
• Impacts care access: Denials can delay or prevent you from receiving needed treatments
• Requires timely action: Most insurance plans have strict deadlines for filing appeals

How Solace can help

A Solace advocate can help you understand denial reasons, gather necessary documentation for appeals, and navigate the appeals process effectively. Advocates can also work with providers to correct billing errors, obtain required authorizations, and negotiate payment arrangements if appeals are unsuccessful.