Receiving a notice that a claim was denied can be confusing and stressful, especially when you've already had your session. This article explains the most common reasons claims are denied and walks you through your options for resolving them.
Key Points
A claim denial means your insurance company declined to pay for one or more sessions; it doesn't necessarily mean the issue can't be resolved.
The most common reasons include out-of-network coverage gaps, incorrect processing, and missing prior authorization.
Your first step is to call your insurer to understand the specific denial reason and ask about reprocessing.
If your insurer reprocesses the claim, obtain a reference number and share it with Grow Therapy's support team so we can update your account.
Some denial types (like having no mental health benefits) can't be reversed, but there may still be options available to you.
Why a claim might be denied
Insurance companies can deny claims for several reasons. Here are the most common ones:
Out-of-network: Your insurance plan may not cover your provider because they're out-of-network. Grow attempts to verify insurance coverage during your initial booking with a provider; however, changes to your insurance plan or the insurance companies your provider accepts can affect future coverage.
Incorrect processing: Insurers sometimes process claims incorrectly. This is one of the more common (and more resolvable) denial types.
Prior authorization required: Some plans require your insurer to pre-approve certain types of mental health services before they're covered.
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: Some plans don't include mental health coverage. If this is the reason for your denial, your options will be more limited. See the FAQ section below.
This isn't an exhaustive list. Your Explanation of Benefits (EOB) or a call with your insurer will identify the specific denial code and reason.
Steps to resolve a denial
Here are the steps to take regardless of the denial reason:
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. Obtain a reference number from your insurer during your conversation. This number is crucial for tracking the claim reprocessing and for any further communication with us.
Once the claim is reprocessed, your insurer will issue a new EOB and send updated remittance advice to Grow Therapy. We'll update your account and issue any applicable refunds at that point.
🌟 Note: Reprocessing can take several weeks, depending on your insurer. If you don't hear back within 30 days, follow up with your insurer directly and let our Support Team know.
When a denial can't be reversed
Some denials, like coverage gaps due to confirmed out-of-network status or a plan that excludes mental health benefits, may not be reversible through reprocessing or appeal. In these situations:
You may be billed at the out-of-pocket rate for affected sessions.
You can request a superbill from Grow Therapy, which you may be able to submit to your insurer for partial reimbursement if you have out-of-network benefits.
You may want to consider switching to a provider who is in-network with your current plan.
Contact our Support Team if you're unsure which of these options applies to your situation.
Frequently asked questions
How long does reprocessing take? It varies by insurer, but most reprocessing requests take 2–6 weeks. Once complete, your insurer will issue a new EOB and notify Grow Therapy. If you've shared a reference number with our support team, we'll update your account when we receive the new remittance.
Do I need to contact Grow Therapy or just my insurer? Start with your insurer; they control the claim. Once you have a reference number from a reprocessing request, contact Grow Therapy's support team to share it so we can follow up on our end. You don't need to contact us before calling your insurer.
What if my plan doesn't include mental health benefits? Unfortunately, this type of denial typically can't be reversed. You may still be able to request a superbill to submit for out-of-network reimbursement if your plan offers it. Contact our Support Team to discuss your billing options.
What if I already paid a balance that should have been covered? If a claim is reprocessed and results in a refund, Grow Therapy will apply it to your account or issue a refund, depending on your payment method. You don't need to take action; we'll update your account once we receive the updated remittance from your insurer.