Protecting Yourself From Insurance Denials: Practical Guidance for Patients

Navigating health insurance can be confusing, and unexpected claim denials are unfortunately common. After managing my own insurance billing for more than 16 years, I’ve learned which steps truly help patients protect themselves. The tips below apply whether you’re seeking acupuncture, chiropractic care, physical therapy,  primary care, or other specialty services.

1. Always Verify Your Benefits Personally

Clinics—including Sullivan Acupuncture—verify benefits as a courtesy, but ultimately patients are responsible for any insurance denials or non‑covered services. Calling your insurance plan directly ensures you understand:

• What services are covered

• Whether deductibles apply

• Any limitations or exclusions

• Your expected out‑of‑pocket costs

Even when a provider verifies benefits, it’s essential that you confirm the details yourself.

2. Always Request a Reference Number

When speaking with an insurance representative:

• Write down the date, time, name of the representative, and the reference number for the call

• Document exactly what you were told

Insurance companies often state that they are “not responsible for information provided over the phone,” yet these reference numbers can be invaluable during appeals—especially when incorrect information was given by Tier One customer service (which happens frequently).

3. Keep a Copy of Your Insurance Handbook

This is one of the most powerful tools patients overlook.

Your employer or insurance plan provides a member handbook (sometimes called a Summary Plan Description). This document outlines:

• Covered services

• Exclusions

• Definitions of deductibles, copays, and out‑of‑pocket maximums

• Prior authorization requirements

• Appeal rights

If you’re unsure about a benefit, consult the handbook first, then call your insurance company to confirm your interpretation.

Additional Tips That Make a Big Difference

1. Understand Your Deductible and Out‑of‑Pocket Responsibilities

Before receiving care, make sure you know:

• Your annual deductible

• Whether the deductible must be met before services are covered

• Your copay or coinsurance

• Your out‑of‑pocket maximum

This prevents surprises when claims process differently than expected.

2. Ask About Service‑Specific Limitations

Every benefit category has rules. When verifying coverage, ask:

• “How many visits are allowed per year?”

• “Are there diagnosis restrictions?”

• “Are there symptoms or conditions that are not covered?”

For example, many insurance plans only cover acupuncture for pain or nausea, not for general wellness or other conditions.

3. Request an Account Manager When Needed

If Tier One or Tier Two representatives give conflicting information or cannot answer your questions, ask to speak with:

• A supervisor, or

• Your assigned account manager

These individuals typically have more accurate information and greater authority.

4. Involve Your HR Department When Appropriate

If your insurance is employer‑sponsored, your HR or benefits manager can be an excellent resource. They can:

• Clarify plan rules

• Assist with denials

• Communicate directly with the insurance carrier

• Advocate on your behalf

This is part of their role, and they can often resolve issues more quickly than patients can on their own.

So many people do not want to deal with the stress of insurance, but don't bury your head in the sand because, ultimately, you are responsible for payment and insurance companies are not above attempting to deny payment when they shouldn't. The above are great ways to cover your tracks.