What is a denial?
Coverage denial is when an insurance company refuses to pay for health care services. There are three times a health plan won’t cover care:
- It doesn’t think you qualify for a treatment or medicine your doctor wants you to get so it won’t preapprove or precertify it. OHA can work with you and your provider to explain to the insurer that you do qualify.
- Your plan won’t cover a treatment you have already received. OHA can work with you and your provider to argue that the treatment should be covered.
- It doesn’t cover a prescribed treatment or medicine, even if you qualify for it. OHA can see if the insurer’s exclusion is lawful and may help you convince them it should cover it. Insurers usually don’t change their minds about this type of denial.