A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which describes the process that will follow the denial?

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Multiple Choice

A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which describes the process that will follow the denial?

When a service isn’t covered by the insurer, the claim is denied for lack of benefit. If there are no errors on the submission, there’s nothing to adjust or correct with the payer. The appropriate next step is to pursue the balance with the patient—the service wasn’t paid by the insurer, so the patient is responsible for the charge. Submitting to another payer isn’t automatic unless there’s a secondary insurer, and appealing is for challenging a denial based on coverage rules or errors, which isn’t indicated here. Therefore, the patient is billed for the non-covered service.

When a service isn’t covered by the insurer, the claim is denied for lack of benefit. If there are no errors on the submission, there’s nothing to adjust or correct with the payer. The appropriate next step is to pursue the balance with the patient—the service wasn’t paid by the insurer, so the patient is responsible for the charge. Submitting to another payer isn’t automatic unless there’s a secondary insurer, and appealing is for challenging a denial based on coverage rules or errors, which isn’t indicated here. Therefore, the patient is billed for the non-covered service.

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