What if my insurance claim is denied?
If your insurance claim is denied or your insurance plan does not cover the visit, you may be responsible for the cost of the appointment. DrHouse submits claims to insurance providers, but coverage decisions are ultimately made by the insurance company based on your specific plan and benefits.
Quick Answer:
- DrHouse submits claims to your insurance provider.
- Insurance companies determine whether a claim is covered.
- If a claim is denied, you may be responsible for the visit cost.
- You will receive information about how the claim was processed through your Explanation of Benefits (EOB).
- The DrHouse billing team can help review billing-related questions and assist you in understanding charges associated with a denied claim.
How Insurance Claim Processing Works
After your virtual visit, DrHouse submits a claim to your insurance provider for the services performed during the consultation. The insurance company reviews the claim and determines how much of the visit cost is covered under your plan.
Once the claim is processed, both you and DrHouse receive an Explanation of Benefits (EOB). The EOB outlines:
- Services that were billed
- The amount covered by insurance
- Any remaining patient responsibility
What Happens If the Claim Is Denied?
If your insurance provider denies the claim or determines that the service is not covered by your plan, you may be responsible for paying for the visit. The standard self-pay price for a DrHouse virtual visit is $129.
If you have questions about the denial or the resulting balance, you can contact DrHouse support. The billing team can review the details of your account, explain the charges, and assist with billing-related concerns.
Limitations and What to Know
Insurance coverage varies by plan. Even when a claim is approved, you may still owe:
- Deductibles
- Copayments
- Coinsurance
The final amount depends on your insurance benefits and how the claim is processed. Cost estimates provided before a visit are good-faith estimates and may differ from the final amount after insurance adjudication.
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