Direct answer
Claims are often denied because the provider does not have a contract with your specific insurance plan, meaning your policy does not cover their negotiated rates. It depends on whether your plan includes ‘out-of-network’ benefits or if the services provided were deemed emergency care, which federal law may protect.
Federal and state regulatory guidelines regarding the No Surprises Act and typical health insurance provider contract disclosures. For additional information about consumer protections against surprise medical bills, see the Centers for Medicare & Medicaid Services‘ comprehensive guide.
What this means for you
Claims are often denied because the provider does not have a contract with your specific insurance plan, meaning your policy does not cover their negotiated rates. It depends on whether your plan includes ‘out-of-network’ benefits or if the services provided were deemed emergency care, which federal law may protect.
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