What does "claims denial" mean?

The term "claims denial" specifically refers to a situation where an insurance company refuses to pay for a healthcare service after a claim has been submitted. This typically occurs when the insurer determines that the services provided were not covered under the patient's policy, did not meet medical necessity requirements, or were submitted incorrectly.

This definition is crucial for understanding the insurance claims process, as a denial can significantly impact a patient's financial responsibility for their healthcare services. When a claim is denied, it often becomes the responsibility of the patient to cover the costs unless the denial can be appealed and overturned.

The other options represent different aspects of health insurance but do not accurately define what a claims denial is. For instance, the approval of a claim is the opposite of denial, while verifying the details of a claim pertains to assessing its validity rather than refusing payment. The method for decreasing out-of-pocket expenses relates to financial strategies within health insurance, rather than the denial of a claim itself.