Understanding Denied Claims
At Alma, we're dedicated to helping you handle your insurance insurance with clarity and confidence. While eligibility checks are a great way to predict your estimated payment responsibility, on rare occasions, insurance companies might deny a claim after a session. If this happens, we want you to feel informed and supported with clear guidance on the next steps.
Starting in late September 2025, if a claim is denied for one of the reasons below, clients will be charged the full amount their insurance says they owe.
- Inactive coverage
- Secondary insurance (Coordination of Benefits)
- Out-of-network health plan
- Medicare/Medicaid health plan
When a denial occurs, both you and your provider will be notified as soon as we hear from the insurance company with the reason for the denied claim and guidance on next steps. To ensure you have time to review with your provider and take action on next steps, you will be notified 10 days in advance of any charges taking place.
If the claim is able to be reprocessed, we'll provide the steps to do so. If your insurance company approves the claim, we will refund you the difference between the original charge and the updated patient responsibility provided by your insurance company.
Continue reading to learn more about how Alma will handle denied claims going forward.
Frequently Asked Questions
Why was this claim denied?
Claim denials will happen for any of the following reasons:
- The insurance company has your policy listed as a secondary insurance plan. This is referred to as a Coordination of Benefits issue. This can happen if you have multiple policies and haven’t designated one as primary yet. You can read more about Coordination of Benefits issues in this article.
- Your insurance policy was inactive on the date of service
- Your insurance plan is out-of-network
- Your insurance plan has limitations on the service that was provided (e.g. restrictions on in-person or virtual care)
- Your insurance plan is a state health plan (Medicare or Medicaid). These plans are not currently accepted by Alma’s Insurance Program
See Why Some Insurance Claims Get Denied to learn more.
What happens when a denial occurs?
Unfortunately Alma can't change insurance company decisions. If you have questions about a denied claim, we encourage you to reach out to your insurance company directly for more details. Please refer to the “Why do I need to do if my claim is denied?” section at the bottom of this article for more detailed instructions on what to have ready when reaching out to your insurance company.
To avoid a buildup of additional denial costs, we'll pause claim submissions through Alma with that specific insurance coverage. When this happens, you have the option to update your insurance coverage with your provider (if relevant) or switch to paying out-of-pocket.
Am I responsible for payment if the claim is denied?
Yes, you will be charged the full amount your insurance indicates you owe if a claim is denied due to inactive coverage, secondary insurance (Coordination of Benefits), or an out-of-network or Medicare/Medicaid health plan.
If you would like to dispute the denial, please review the email you receive regarding the denial to follow the outlined steps. You can always call your insurance company to confirm any details about your insurance coverage that is needed to dispute the denial.
Even if you provide the necessary information for Alma to resubmit the claim to your health plan, you will still be charged 10 days after being notified about the denied claim. If the claim reprocesses successfully and is not denied again, you will be refunded the difference between the cost of the denied claim and your new payment responsibility. A new invoice will always be sent to you and your provider if invoices are adjusted after a claim returns from the insurance company.
Will I be notified before being charged for a denied claim?
Yes, you will receive an updated invoice with your new payment responsibility via email 10 days before your card on file is charged.
How can I reduce the risk of denials?
- Always double-check your insurance coverage and contact information before an appointment, especially if you’ve recently changed jobs or experienced a life event, and be sure to share any updates with your provider.
- Keep your insurance and demographic information up to date and communicate any upcoming changes to your provider proactively to prevent coverage issues. Missing or mismatched client demographics, like your name, date of birth, or address are common causes for denials that are easy to fix.
- Before sessions begin, let your provider know if you have multiple insurance plans and clarify which is the primary one. If you have multiple insurance plans, ensure that your provider has your primary plan listed in the Alma portal. You can reference this article to learn more about primary and secondary health plans and can always call member services for your health plans to determine which plan is primary vs. secondary.