Life Kit: Health What to do when your health insurance denies coverage
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Sep 18, 2025 Jackie Fortier, a KFF Health News reporter specializing in health policy, shares vital insights on what to do when your health insurance denies coverage. She breaks down the process of appealing denials, discussing essential steps and documentation needed for a successful case. Fortier also touches on preventive care requirements under the ACA and how to navigate billing disputes. She even provides advice on escalating the issue if initial appeals fail, including external reviews and financial assistance options.
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Preventive Care Is Law, But Conditional
- The Affordable Care Act requires many preventive services to be covered with no cost-sharing.
- Eligibility for each service depends on age, gender, and medical history, so check specifics before you go.
Confirm Coding During Wellness Visits
- Ask your doctor how they will code any issue that arises during a wellness visit before leaving the office.
- Clarify whether problems discussed will be billed separately so you avoid surprise copays or deductibles.
Verify Claims Before Paying
- If you get a bill for a preventive service, first confirm the provider submitted a claim to your insurer.
- If no claim was submitted, ask the billing office to file it correctly instead of paying the bill immediately.