Denial reason group 3

Your insurance company has denied your claim for the following reasons:

  • Lack of authorization or pre-certification prior to services
  • Lack of referral authorization
  • Authorization number is missing or invalid

Steps you should follow to appeal insurance denials:

  • Did you receive authorization prior to services?
    • If yes, contact your insurance company and discuss why the charges were denied and ask that they be reprocessed.
    • If no,
      • Log on to Mayo Clinic patient online services.
        • Select the Medical Record and Results menu.
        • Print the required medical records pertaining to the denied charge.
        • Print the supporting doctor's notes prior to and after the procedure, indicating why the denied service was ordered and what the results were.
        • Make copies of all documentation for your own records.
        • Complete and print the appeal form (PDF) and send via certified mail to your insurance company with the above supporting documentation and a copy of your EOB showing the denied charges.
  • Did you obtain a referral authorization from your primary care physician?
    • If yes, contact your insurance company and discuss why the charges were denied and ask that they be reprocessed.
    • If no, contact your primary care physician and request that he or she provide a referral authorization to your insurance company.
May 21, 2016