A Denial or Unexpected Bill: What to Do Next
A denial or bill can feel like the end of your options. Start by identifying exactly what was denied or charged, who issued it, and the next deadline. Keep copies so you do not have to retell the whole story on every call.
To print this guide, use your browser’s Print command.
No email or account is required. Use the PDF or printed spaces for private notes. This guide does not collect worksheet answers. Save and reopen a completed PDF to check your notes.
Separate the Documents
| Document or answer | Question to ask |
|---|---|
| Provider bill | Which service and date is this for? Is it the final balance, and was it submitted to my plan? |
| Plan explanation or denial | What was covered or denied, for what reason, and what review options apply? |
| An estimate from before care | What changed between this estimate and the amount billed? |
| A verbal answer | Can you send the reason, next step and deadline in writing? |
A health-plan appeal asks for a decision to be reconsidered. An internal appeal is reviewed by the insurer; an external review uses an independent third party. If a case is urgent, the internal review process must be expedited. The notice and plan rules tell you how to request the applicable review. An appeal is different from asking a provider to correct a billing error or offer financial assistance.
Sources: [1]
Gather These Before the Call
- The notice or bill, service date, provider name, claim or reference number and the stated reason.
- Any deadline printed on the notice. Ask what action must arrive by that date.
- The estimate, prior authorization, referral or coverage answer you already received, if relevant.
- The correction or explanation you are asking for. Ask the treating clinician whether supporting information is needed.
Sources: [1]
Your Review Record
- Decision, reason and deadline
- Copy the exact reason; note where the deadline came from.
- People contacted and their answers
- Date, department, name, reference number and what they agreed to do.
- Documents and next action
- What you will submit, to whom, how you will confirm receipt and when to follow up.