Why Your Insurance Denied the Claim — And What You Can Do About It

Dealing with a denied insurance claim? You're not alone.
Many patients feel frustrated and confused when their insurance doesn’t cover a medical bill they thought was included. At CareSounds, we help people understand the reasons behind denials—and how to fix them.

Here’s a simple guide to help you take control:

1. Understand the Reason for Denial

Every denied claim comes with a “reason code” or short explanation. It might be due to a missing document, wrong billing code, or your plan not covering the service. Read this section carefully.

2. Check for Billing or Coding Errors

Sometimes, the issue is as simple as a typo. A wrong date, procedure code, or patient detail can cause a claim to be rejected. If you’re unsure, let CareSounds review it for you.

3. Review Your Insurance Coverage

Go back to your insurance plan. Was pre-authorization needed? Was the provider in-network? If not, the service may not be covered—or only partially.

4. Call Both Your Provider and Insurance

Speak with both sides:

• Ask your provider’s billing office if they can resubmit or correct the claim.

• Talk to your insurance company about appeal options or next steps.

5. File an Appeal (Yes, You Can!)

Most insurance companies allow appeals within a set time. You’ll need to write a short letter, include any documents, and explain why the claim should be approved. CareSounds can guide you through this process.

Let CareSounds Handle the Stress for You

We specialize in managing billing issues, denied claims, and confusing insurance processes—so you don’t have to. Let us help you get the coverage you deserve.