Claims & Eligibility

Learn about eligibility rules and what to do if a claim is denied.


Prior Authorization for Prescription Drugs
Health plans may require “prior authorization” before covering some prescriptions. It's a doctor-insurance matter, not your pharmacy.
Precertification for Medical Services
A precertification means an insurance carrier has deemed a treatment as "medically appropriate." It is not a guarantee that it will be covered.
What is an Explanation of Benefits?
An EOB breaks down your share of medical costs. You should keep it for your records.
Appealing a Claim Denial
Insurance carriers have to tell you why they’ve denied your claim, and they have to let you know how you can dispute their decisions.

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