What to do when a claim is denied
Read the reason, then follow the instructions on your own paperwork.
A denial notice or EOB gives a reason code and a short explanation. That wording is the starting point for everything else.
Ask your insurer to explain the reason in plain language and what information would let them reconsider. Sometimes it is a missing referral, a coding detail or a date.
If you appeal, use the instructions, addresses and timeframes printed on your own documents. Attach the EOB, the bill and the denial letter, and keep copies of everything you send.
We never invent deadlines or plan terms. Anything about your specific coverage has to come from your plan documents or your insurer.
Have a bill and an EOB that don't match?
Upload both and the Detective will compare them line by line and explain any potential discrepancies in plain English.
Compare my bill and EOBMore guides
- How to read a medical bill
- Deductible, copay and coinsurance in plain English
- Why asking for an itemized statement helps
- Talking to a billing department
- All guides
Important: The Medical Bill Detective provides informational assistance based on the documents you provide. It does not provide medical, legal, insurance, or financial advice and does not determine whether a bill is legally valid, fraudulent, or incorrect. Potential discrepancies should be verified with your healthcare provider and/or insurance company.