Find Information About:

Drugs & Supplements

Get information and reviews on prescription drugs, over-the-counter medications, vitamins, and supplements. Search by name or medical condition.

Pill Identifier

Pill Identifier

Having trouble identifying your pills?

Enter the shape, color, or imprint of your prescription or OTC drug. Our pill identification tool will display pictures that you can compare to your pill.

Get Started

My Medicine

Save your medicine, check interactions, sign up for FDA alerts, create family profiles and more.

Get Started

WebMD Health Experts and Community

Talk to health experts and other people like you in WebMD's Communities. It's a safe forum where you can create or participate in support groups and discussions about health topics that interest you.

  • Second Opinion

    Second Opinion

    Read expert perspectives on popular health topics.

  • Community


    Connect with people like you, and get expert guidance on living a healthy life.

Got a health question? Get answers provided by leading organizations, doctors, and experts.

Get Answers

Sign up to receive WebMD's award-winning content delivered to your inbox.

Sign Up

Font Size

Denied Medical Care?

By Loren Stein
WebMD Feature

June 5, 2000 -- Nothing can be more frustrating or confusing than to show up at your doctor's office with symptoms of a health problem, only to be told you can't get the diagnostic test you want, a referral to a specialist, or a specific medical treatment.

Administrative appeals and legal recourse are possible long-term remedies, but in the meantime your health or life may be at risk. Although it's possible to beat your doctor or even your health plan in court, experts say patients are better off if they can settle such disputes without involving the legal system.

Recommended Related to Health Ins & Medicare

How to Negotiate Your Medical Bill

You haggle at the car dealership, at the farmers market, and at flea markets. But your doctor's office? That doesn't occur to most people. Yet there's a lot of room for negotiation over medical care costs, says John Santa, MD, a medical expert with Consumer Reports. Simply speaking up about money can make a difference in what you'll ultimately pay, Santa says. "When people are stressed financially, that's helpful information [for a doctor] in terms of taking care of them medically," he says. "That...

Read the How to Negotiate Your Medical Bill article > >

"Consumers who have health or medical problems often feel overwhelmed or powerless, and it can be intimidating to confront your doctor or health plan," says Bridget Sheehan-Watanabe, health policy analyst and staff attorney for the Center for Health Care Rights in Los Angeles. "But once a consumer has an understanding of how to resolve the issues and knows where the problem lies, she can often be successful in getting the care she needs."

Before requesting an appeal ?- which can take several months to resolve ?- experts suggest a number of initial steps to expedite the process. Contacting an attorney can also help. The presence of an attorney and the threat of a lawsuit may make the doctor, hospital, or health plan take notice, experts say. Moreover, "Everything is negotiable," writes consumer advocate Jamie Court in his book Making a Killing: HMOs and the Threat to Your Health. Here are some tips:

  • Try to establish open communication with your doctor. Remain calm and reasonable. Find out why you were denied care and who denied it -- the doctor, the medical group, or your health plan. Did the doctor put in an authorization request and receive a denial? If so, make sure he or she gets involved in trying to get your benefits. If you feel intimidated or uncomfortable questioning your doctor, bring someone else with you. Put your questions in writing before going in, and take notes.
  • Ask your doctor how she is paid, and about any financial arrangements she may have with the medical group or health plan. If your doctor has a financial incentive to deny tests or referrals under "capitation," (where your doctor or a medical group is paid a set monthly fee per patient), you may be able to enlist the help of your HMO, which would face no added expenses, having already paid for the care you should receive.
  • Immediately ask for a second opinion from your physician's supervisor. Then get another opinion from a qualified professional outside the HMO network, if possible. "Find allies in the medical profession," says Jamie Court. "When medical experts advocate care, HMOs find it harder to deny treatment."
  • Go to the administrator in charge of your doctor's medical practice and explain the need for the test or treatment.
  • Request a written denial.
  • Document everything. Make sure your doctor documents your treatment and its necessity. Get a copy of your medical records.
  • Find out the timelines within which your treatment or coverage decision must be made -- taking into account the deadline when failure to get the test or treatment may result in harm to you. Most states have regulations establishing such time frames. Make sure you communicate clearly that you know the timeline and that it must be met.
  • Get a patient advocate. "This is important because you need someone to advocate for you who's not afraid to challenge anybody, because if you're sick, you're not going to do it," says Wanda J. Jones, president of New Century HealthCare Institute in San Francisco. Find out who can assist you; contact your state HMO regulatory agency or consumer advocacy groups.
  • When your health is at stake, you may have to resort to going outside the plan and paying for care directly. If the treatment is expensive and you're unable to pay for it, this may mean taking more drastic steps such as taking out a loan, getting a second mortgage, or asking for financial help from friends or relatives.

Hot Topics

WebMD Video: Now Playing

Click here to wach video: Dirty Truth About Hand Washing

Which sex is the worst about washing up? Why is it so important? We’ve got the dirty truth on how and when to wash your hands.

Click here to watch video: Dirty Truth About Hand Washing

Popular Slideshows & Tools on WebMD

disciplining a boy
Types, symptoms, causes.
Remember your finger
Are You Getting More Forgetful?
fruit drinks
Eat these to think better.
No gym workout
Moves to help control blood sugar.
acupuncture needle on shoulder
10 tips to look and feel good.
Close up of eye
12 reasons you're distracted.
birth control pills
Which kind is right for you?
embarrassed woman
Do you feel guilty after eating?
Epinephrine Injection using Auto-Injector Syringe
Life-threatening triggers.
woman biting a big ice cube
Habits that wreck your teeth.
pacemaker next to xray
Treatment options.
caregiver with parent
10 tips for daily life.

Pollen counts, treatment tips, and more.

It's nothing to sneeze at.

Loading ...

Sending your email...

This feature is temporarily unavailable. Please try again later.


Now check your email account on your mobile phone to download your new app.

Women's Health Newsletter

Find out what women really need.