What should individuals do first after receiving a denied claim?

When a claim is denied, the first step individuals should take is to read the Explanation of Benefits (EOB) to understand why the denial occurred. The EOB provides essential information regarding the claim, including the specific reasons for the denial, which may include issues like billing errors, services not covered, or insufficient documentation. Understanding the rationale behind the denial is crucial because it guides the next steps the individual can take, whether that involves gathering additional information, correcting errors, or preparing a formal appeal.

Skipping the review of the EOB or acting hastily by filing an appeal may lead to misinformed actions, potentially prolonging the resolution process. Contacting the healthcare provider directly can also be helpful but may not address the specifics of the claim denial initially. Lastly, seeking legal advice right away is generally not the first action because many denials can often be resolved through review and communication with the insurer or provider without needing legal intervention. Overall, reading and comprehending the EOB equips individuals with the knowledge they need to effectively address the claims denial.