A retroactive denial happens when a claim that was previously paid is later denied. If this occurs, you may be responsible for paying for the services received.
This can happen for reasons such as:
- A claim was paid during the second or third month of a grace period, but premiums were not paid in full.
- A claim was paid for services received when you were not eligible for coverage.
How to help avoid a retroactive denial
You can reduce the risk of a retroactive denial by:
- Paying your premiums in full and on time.
- Checking that the services you receive are covered by your health plan.
- Using providers in your plan's network whenever possible.
- Asking your provider if a service requires authorization or has coverage limitations before receiving care.