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How to challenge an hmo's denial of coverage
Determine if you have been denied coverage by reading your insurance policy carefully.
Sometimes an hmo will need to investigate a claim further. While its investigation is pending, the hmo may put a hold on the claim.
However, an insurance company failing to respond can also amount to an outright denial; it depends on your individual policy. Read carefully through any pre-certification letter or evidence of benefits (eob) statement that explains why your claim has been denied.