My insurance won't pay for my surgery — what now?
Don't panic. Most surgery payment disputes are reversible with the right appeal.
A non-payment can mean different things: claim was denied (medical necessity, prior auth absent, exclusion); claim is in process (still under review); the bill is your responsibility (deductible, copay, OOP max not met); or you received an EOB but no actual bill (just informational). Identify which.
Steps
- Read the Explanation of Benefits (EOB) carefully — find the CARC code explaining the denial
- Determine whether you actually OWE the amount (PR group code) or the provider wrote it off (CO group code)
- If the claim was denied, file an internal appeal
- If the claim was paid but reduced (out-of-network, allowed amount), check NSA balance-billing protections
- DenialHelp can help draft the appeal in 5 minutes
Frequently asked questions
My insurance won't pay for my surgery — what now?
A non-payment can mean different things: claim was denied (medical necessity, prior auth absent, exclusion); claim is in process (still under review); the bill is your responsibility (deductible, copay, OOP max not met); or you received an EOB but no actual bill (just informational). Identify which.
What are the steps?
1. Read the Explanation of Benefits (EOB) carefully — find the CARC code explaining the denial; 2. Determine whether you actually OWE the amount (PR group code) or the provider wrote it off (CO group code); 3. If the claim was denied, file an internal appeal; 4. If the claim was paid but reduced (out-of-network, allowed amount), check NSA balance-billing protections; 5. DenialHelp can help draft the appeal in 5 minutes
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