What should be done when a claim is denied for lack of medical necessity?

When a claim is denied due to lack of medical necessity, submitting an appeal is the appropriate course of action. An appeal allows the medical office to formally request a review of the denial by the insurance company. During this process, it is essential to provide additional information or documentation that may support the necessity of the services rendered. This can include medical records, physician's notes, or relevant clinical guidelines that justify the treatment provided to the patient.

Submitting a new claim with additional documentation could be an option, but it typically does not address the denial directly nor ensure that the claim will be properly reconsidered under the original context. Filing a complaint with the insurance company does not directly resolve the denial but may address broader issues with the insurance provider, which is not immediately valuable in case of a specific denial related to medical necessity. Writing off the charge is not advisable as it does not seek to recover the payment nor does it advocate for the services provided, ultimately impacting the practice’s revenue. Therefore, an appeal is the most effective method to potentially overturn the denial and ensure that the medical services are fairly compensated.