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Claim Denials

Delivering the coverage you deserve

At Denials Management, we handle all types of claim denials and specialize in helping you get the coverage you deserve. Our team of experts can help you through every step of the process, no matter what the reason is that your claim was denied. Medical, mental health, and prescription drug claims can be denied for a wide variety of reasons, and we have experience fighting all types of denials. Learn more about how we can help with your specific claim denial and get started today!

 

Medical Necessity

Denials of Medical Necessity are some of the most common and challenging types of claim denials. Medical necessity is determined by the insurance company and simply means whether or not they deem the procedure, treatment, or service medically necessary. Unfortunately, insurance companies often issue these denials without a thorough review of the patient history and often without even conducting an examination of the current treatment records. At Denials Management, we have successfully advocated for thousands of patients who have had their insurance coverage incorrectly denied because a carrier does not believe the care to be medically necessary. We are ready to fight to get you and your family the medical coverage you deserve.

No Pre-Authorization

Depending on your insurance provider, pre-authorization is required for certain types of medical treatments, tests, or medications. Unless you know your policy inside and out, sometimes it can be difficult to remember what needs pre-authorization and what does not. We provide insurance policy review services that can prevent this from happening, but we are also skilled in overturning this frequent claim denial.

Substance Abuse

When a loved one is struggling with substance abuse, seeking treatment is a top priority. Unfortunately, health insurance companies don’t always cover this. A denial for substance abuse treatment is one of the most common claim denials we see. Our team specializes in fighting these denials and getting you and your family the coverage you need and deserve.

Mental Health Parity Appeals

If you or a loved one struggles with mental health issues, you know how important it is to seek help. Unfortunately, not all insurance companies feel this way. As one of the most common health insurance claim denials, we have seen this happen time and time again. Our team is experienced in handling this type of claim and can help you and your family today.

Experimental & Unproven Procedures

While technically classified as a medical necessity determination,  an insurer’s claim that a drug or procedure is experimental and unproven requires special handling. These denials are often issued in error, and can usually be disproved by the prevailing medical literature, or by the documented recommendation of your provider. Even if the procedure in question is considered experimental or unproven, there are a myriad of reasons why an individual may need such a  procedure, and we understand why these procedures need to be covered. Our experts can assist you in getting coverage for the care you need.

Suggested Wording for Mental Health/Substance Abuse Parity Appeals

 

If you or a loved one struggle with mental health or substance abuse issues, you know how important it is to seek help. Unfortunately, health insurance companies don’t always see it that way. If you or a loved one has had mental health or substance abuse care denied, your insurance carrier may be in violation of federal Mental Health Parity law, which requires all insurers to treat mental health and substance abuse care the same as they would medical care. Denials Management is the national leader in Parity Appeals, and one of our experts can help you fight to get equal coverage for mental health and substance abuse care.

Don’t See Your Claim Denial?

If the reason why your claim was denied isn’t listed here, no need to worry. We are experienced in dozens of types of claim denials. We’re more than happy to look over your claim denial and see what we can do to help.