If the health insurance company denies the claim because it doesn’t deem it medically necessary, you should contact your doctor and request documentation to show that the provider considers the treatment medically necessary.
If you’re not sure what to do when insurance denies surgery or another procedure, start with proving medical necessity. Ask the provider to write a letter or contact the insurance company about why the treatment is medically necessary.
You should also ask the provider to check the diagnostic codes used in the claims. Sometimes, incorrect diagnostic codes, which the insurer uses to review claims, are incorrect. Ask the provider to review to make sure that’s correct. If it’s not correct, the provider can resubmit the claim.