What to Do When Insurance Was Not Applied

Confirm whether a claim was ever filed

The most common cause is simple: the claim was never submitted, or was submitted with incorrect insurance information. Before assuming a denial, ask the provider directly whether a claim was filed and what the outcome was.

Then ask your insurer whether they received a claim for that date of service. If they have no record, the issue is on the submission side, not the coverage side.

Check the information on file

Member ID numbers, group numbers, dates of birth, and plan effective dates are all common points of failure. A single transposed digit will cause a claim to reject.

Give the billing office your current card information and ask them to resubmit. This resolves a large share of these situations without any dispute at all.

If the claim was denied

A denial is not the end of the process. Ask for the specific denial reason code and what it means. Some denials are administrative and can be corrected by resubmission; others require a formal appeal through your insurer.

Your EOB will generally list the denial reason. Your insurer is required to explain the basis of a denial and the process for appealing it.

Request reprocessing in writing

If the provider needs to resubmit, ask for confirmation in writing that they have done so, along with the date. If your insurer needs to reprocess, request that in writing as well and note any reference number.