A claim denial occurs when an insurance company refuses to pay for a healthcare service or procedure that was submitted as a claim. Understanding these denials and their reasons is crucial for addressing and potentially resolving the issue.
Common claim denial situations
Occasionally, your insurance may not cover a session. This status can occur for several reasons. Here are some common situations that may lead to a claim denial:
🌐 Out-of-Network: Your insurance plan may be out-of-network for your provider. Grow attempts to check and verify insurance coverage during your initial booking with a provider; however, changes to your insurance plan or to the insurance companies that your provider accepts can impact future coverage.
❌ Incorrect Processing: Claims are sometimes processed incorrectly by insurers.
📋 Authorization Requirement: Your insurance may require prior authorization for certain services.
💻 Vendor Requirements: Some insurance plans mandate the use of specific telehealth vendors, which might not have been recognized in advance or may have changed during your time receiving care from a Grow provider.
🧠 No Mental Health Benefits: Your insurance plan may not include mental health benefits.
While this list covers common scenarios, there are various other reasons why a claim might be denied.
Steps to understand & resolve a denial
Regardless of the reason for a denial, you can take steps to understand and potentially reverse a denied claim, including:
📞 Contact your insurer: Call the number on the back of your insurance card to speak with your insurance company.
✅ Verify coverage: Compare the claims with your benefit package to ensure accuracy.
💳 Request Reprocessing: If your insurer determines the claim was processed incorrectly, they will reprocess the claim and notify us. Please obtain a reference number from your conversation with your insurer. This number is crucial for tracking the claim reprocessing and for any further communication with us.
Once the claim has been reprocessed, you will receive a new Explanation of Benefits (EOB), and Grow Therapy will receive updated remittance advice. We will then update your account and issue any applicable refunds.
Additional support
If you have any additional questions or need further assistance, please contact us through the help widget at the bottom right-hand corner of your client portal to start a chat or send us a message.