What To Do If Your Claim Gets Denied
SPECIAL REPORT: What To Do If Your Claim Gets Denied
Intro: Denied Doesn’t Mean Done
You submitted your claim expecting a reimbursement — and then came the email or letter: “Your claim has been denied.”
Don’t panic, and don’t assume it’s final.
Most claim denials are caused by technical errors, missing documentation, or misunderstandings — all of which can be corrected. This special report walks you through why claims are denied, how to fix it, and how to make sure it doesn’t happen again.
🧾 Most Common Reasons Claims Get Denied
| Reason | Example |
| Missing or incorrect receipt info | No RMT license number, missing dates or service description |
| Ineligible provider | Therapist not licensed or outside approved scope |
| No referral submitted | Some plans require a doctor’s note first |
| Benefit maximum reached | You’ve already claimed your yearly limit |
| Service not covered | Cupping, supplements, or add-ons may not qualify |
| Submission deadline missed | Most plans require claims within 12 months |
✅ Step-by-Step: How to Respond to a Denial
- Read the denial message carefully: Look for the specific reason code or explanation.
- Contact your insurer: Call the number on the back of your benefits card and ask, “Can you clarify what’s missing?”
- Review your receipt or claim form: Was anything left out? Does it list the provider’s full name, license number, and service type?
- Gather supporting documents: This could include a corrected receipt, doctor’s note, or letter from your clinic.
- Resubmit with a cover note: Explain clearly, “This is a resubmission correcting the previous missing info.”
- Track the follow-up: Most responses take 5–10 business days.
💬 Ruby at insurance.rmtclinic.net can help draft resubmission notes and check receipt formats for you.
🧠 Know Your Rights: You Can Appeal
If your corrected claim is still denied and you believe it should be covered:
- Request a written explanation of the denial
- Submit a formal appeal letter with your supporting documents
- Ask for a review by a claims supervisor or “escalated inquiry”
Many appeals succeed, especially when your provider is RMT-certified and services are eligible.
🔍 How to Prevent Denials Next Time
- ✅ Always use a provider listed at RMTClinic.net for verified RMT, chiro, and physio services
- 🧾 Make sure receipts include all necessary info:
- Full name of provider
- License number and designation (e.g. RMT)
- Description of service
- Clinic address and date of service
- 📥 Submit claims within your plan’s required timeframe (often 12 months)
- 📋 Ask upfront if a referral is required
- 💬 Use Ruby to review and prep all claims before sending
✅ Action Checklist
- 🔍 Review your denial notice carefully
- 📞 Call your insurer to clarify
- 🧾 Get a corrected or complete receipt
- 📬 Resubmit with a clear explanation
- 🧠 If needed, file a formal appeal
🏥 Use RMTClinic.net to avoid future denials
✍️ About the Author
Henry Tse is the founder of the RMT Clinic Network Organization. With decades of experience advising both practitioners and patients, he empowers Canadians to navigate insurance with clarity, confidence, and care.
