What’s the Best Way to Handle Patient Concerns About Denied Claims?

Denied insurance claims can feel like a curveball for patients and providers alike. Patients might wonder why they’re left holding a bill they didn’t expect, while providers face the challenge of balancing revenue collection with patient satisfaction. But there’s good news: with the right approach, handling denied claims can become an opportunity to strengthen relationships and streamline your processes.
Let’s explore strategies that healthcare practices can use to address patient concerns effectively and leave a lasting positive impression.

What’s the Best Way to Handle Patient Concerns About Denied Claims?

What’s the Best Way to Handle Patient Concerns About Denied Claims?

Empathy is Your First Line of Defense
When patients call about a denied claim, emotions often run high. Many feel blindsided, frustrated, or even angry. This is where empathy becomes your most powerful tool. It’s not just about solving a problem; it’s about making patients feel heard.
Instead of jumping straight to technical explanations, start with a statement that validates their feelings. Something as simple as, “I understand this situation can be overwhelming, but let’s go through this together,” can set a collaborative tone.
Empathy not only calms the situation but also creates trust, showing patients that their concerns are your priority.

Simplify the Complexity of Insurance
The world of health insurance is complicated, and most patients don’t know the intricacies of coverage, claims, and denials. This lack of understanding can amplify their frustration. That’s why simplifying the explanation is essential.
Avoid technical jargon and focus on clarity. If a denial is due to an error, explain it in straightforward terms. For example:

• “It looks like the insurance company needs more information about the treatment you received.”
• “The service was denied because the insurance company didn’t consider it a covered benefit under your plan.”

Breaking down the issue in a way that’s easy to understand helps patients feel less intimidated and more in control.

Dig Deep into the Denial
Every denied claim comes with a reason, whether it’s a coding error, a missing pre-authorization, or an eligibility issue. Reviewing the details thoroughly is crucial before communicating with the patient. The denial notice or Explanation of Benefits (EOB) will usually provide clues about the problem.
Look for:

• Errors in coding or documentation.
• Gaps in insurance coverage or eligibility.
• Failure to secure pre-authorization for the service.

Once you’ve pinpointed the issue, decide on the next steps to resolve it. Patients appreciate transparency, so keep them informed about what’s being done to fix the situation.

Empower Patients While Offering Support
Sometimes, resolving a denial requires the patient’s involvement, such as contacting their insurer or providing additional information. While many patients are willing to help, they often feel unsure about what to do. This is where clear guidance makes all the difference.
Walk them through the process with actionable instructions:

• “You can call your insurance company to confirm coverage for this service. Let them know we’re happy to provide any documentation they need.”
• “The denial is related to a missing referral. If you can request one from your primary care provider, we can resubmit the claim.”

Patients feel empowered when they understand their role in resolving the issue, but offering to handle complex steps—like appeals—can further ease their stress.

Navigating the Appeals Process with Confidence
Not every denial sticks. Many claims are overturned through the appeals process, but the thought of filing an appeal can overwhelm patients. By stepping in or guiding them, you can simplify the journey and increase the chances of success.
What makes an appeal effective? Here are a few essentials:

• Timeliness: Submit the appeal within the payer’s deadlines.
• Accuracy: Ensure all documentation, including medical records and corrected claims, is complete and accurate.
• Clarity: Provide a concise explanation of why the service meets the payer’s criteria for approval.

Patients feel reassured when they know the appeal is in good hands, whether it’s managed entirely by your team or a collaborative effort.

Financial Flexibility Eases the Stress
While denied claims are being resolved, patients may worry about how they’ll cover unexpected out-of-pocket costs. Offering financial flexibility can alleviate their concerns and demonstrate your practice’s commitment to their well-being.
Consider options such as:

• Flexible payment plans that allow patients to pay over time.
• Prompt-pay discounts for those who can pay a portion upfront.
• Financial assistance programs for patients who qualify.

Creating these pathways shows empathy and builds goodwill, even in difficult situations.

Preventing Denials Before They Happen
Proactively preventing denials is the ultimate solution to patient concerns. While no system is perfect, there are steps your practice can take to reduce the likelihood of claims being denied.
Key Prevention Strategies:

1. Verify Insurance Coverage: Always confirm patient benefits and eligibility before appointments.
2. Master Accurate Coding: Ensure coding is consistent with the services provided and payer requirements.
3. Secure Pre-Authorizations: For services requiring authorization, double-check approvals before the patient’s visit.
4. Document Thoroughly: Make sure clinical documentation supports the billed services and meets medical necessity requirements.

Preventing denials not only reduces the administrative burden but also keeps patients from experiencing unnecessary frustration.

Why Handling Denied Claims Well Matters
​Denied claims aren’t just an administrative issue; they’re a patient experience issue. How you handle these concerns reflects your practice’s values and priorities. A patient who feels supported during a stressful situation is far more likely to trust your team and recommend your services.
Satisfied patients lead to:

• Increased loyalty to your practice.
• Positive word-of-mouth referrals.
• Fewer complaints and escalations.

In the long run, managing denied claims effectively is an investment in both patient satisfaction and your practice’s reputation.

Measuring Success and Driving Improvements
Once you’ve established processes for handling denied claims, it’s important to track their effectiveness. Are patients satisfied with how their concerns are resolved? Are your efforts reducing denial rates over time?
Some metrics to consider include:

• The percentage of denied claims successfully appealed.
• Time to resolution for denied claims.
• Patient feedback on their experience.

Regularly reviewing these metrics helps you identify areas for improvement and ensures your practice remains responsive to patient needs.

A Positive Example of Resolution
​Imagine this: A patient named Sarah calls your office upset about a denied claim for her physical therapy session. She had assumed her insurance would cover it, but now she’s staring at a bill she can’t afford.
Your team immediately reviews the denial and finds that it was due to a missing authorization. After explaining the situation to Sarah, your billing department works quickly to appeal the claim, submitting documentation to demonstrate medical necessity. While waiting for the appeal decision, you offer Sarah a manageable payment plan to ease her financial worries.
A few weeks later, the appeal is approved, and Sarah is reimbursed by her insurance. Grateful for the support, she leaves a glowing online review and continues her care with your practice.

Addressing patient concerns about denied claims doesn’t have to be a headache. By leading with empathy, educating patients, and refining your processes, you can turn a common frustration into a moment of connection and trust. Every denied claim is an opportunity—not just to resolve a billing issue but to show your patients that their care matters to you in every way.