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Claims & Coverage QuestionsCall me before you pay anything.

Most of these questions need a real conversation rather than a self-service answer. Tap any topic to see what to do.

Will This Procedure Be Covered?
Before you schedule something expensive, let's check what you'll actually owe.
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    Ask the provider's office for the CPT codes Every procedure has a billing code. Get them in writing before the appointment.
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    Confirm the provider is in network Use your carrier's provider finder, or call the carrier directly. Don't rely on the provider's office to tell you.
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    Send me the details before you schedule I can help you understand what's covered, what you're likely to owe, and whether a different timing or facility makes sense.

The best time to figure this out is before the appointment, not after the bill arrives.

Send Me the Details
A Claim Was Denied
Denials can often be appealed. Don't pay until we look at it together.
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    Find your Explanation of Benefits (EOB) This is the document from the carrier showing what was billed, what was paid, and the reason for denial. Usually available in your member portal.
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    Don't pay the provider yet A denied claim often has an appeal window. Paying it can complicate the appeal.
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    Send me the EOB and the provider bill We'll figure out whether to appeal, what to dispute, and the right way to move forward.

Denied claims have a deadline to appeal — don't sit on this one.

Send Me the EOB
Surprise Bill or Balance Bill
Got a bill that's bigger than expected, or from a provider you didn't choose. Don't pay it yet.
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    Hold off on payment Federal "No Surprises Act" protections may apply. Paying immediately can waive some of your rights.
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    Gather the bill and the EOB I need both documents to figure out whether the charge is legitimate.
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    Send everything to me before you call the provider Many surprise bills are resolved by the carrier directly. Sometimes it's a billing mistake. Sometimes it's negotiable.

If you've already paid, it's still worth reviewing — refunds happen.

Send Me the Bill
In-Network or Out-of-Network?
Network status determines what you pay. Confirm before booking, not after.
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    Use your carrier's provider finder Log into your member portal and search by provider name or specialty. This is the most accurate source.
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    Verify with the provider's office, but don't fully trust them Office staff often say "yes we take that insurance" when they mean "we'll bill it" — not the same as in-network. Always cross-check with the carrier.
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    Still stuck? Send me the provider's name and location I'll look up their NPI (National Provider Identifier — a 10-digit ID every provider has) and check directly with the carrier so you get a definitive answer.
Prior Authorization
Some procedures require approval before they happen. The provider usually handles this — but verify.
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    Ask the provider's office: "Has prior authorization been submitted?" For surgeries, imaging, and many specialty drugs, this is required. If it's missed, the claim gets denied.
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    Get the authorization number in writing Once approved, the carrier issues an authorization number. Save it. If there's a claim issue later, this is the proof.
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    If something isn't getting authorized, let me know Sometimes there's a workaround, an appeal, or a coding issue that's fixable.