Also called: claim denial, coverage denial
A denial is a decision by your health plan not to pay for or not to approve a service. Denials can happen before care through a rejected prior authorization, or after care when a claim is not paid. Every denial should come with a reason code and instructions for appealing, and most denials can be challenged.
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Disclaimer: This definition is provided for general educational purposes only and is not legal, medical, or insurance advice. Insurance rules, deadlines, and terminology vary by plan, state, and over time. Always check your own plan documents and confirm current details before acting.