The Service Was Performed. The Authorization Was Not Obtained.

It has happened in every practice. The service was delivered, the authorization was not obtained, and the claim denied. What follows determines whether it becomes a write-off, a recovery, or a compliance problem.

Step one: was authorization actually required?

Check the plan's requirement for that code, that site of service, that date. Requirements change, and staff sometimes obtain authorizations that were never needed — and sometimes skip ones that were added recently.

Step two: does a retroactive path exist?

Emergency, retroactive eligibility, or documented payer error may support an after-the-fact request. Windows are short and run from the service date rather than from discovery.

Step three: is it appealable?

If the service was clearly medically necessary and the failure was administrative, an appeal is sometimes successful — particularly where the plan's own systems contributed. Document the attempt if there was one.

Step four: can the patient be billed?

This is where practices create real exposure. In many contracts, a provider may not bill the patient for a service denied because the provider failed to obtain authorization. The failure was yours, and the contract assigns the loss accordingly.

Billing the patient anyway can breach the payer contract, and where the patient is covered by certain programs it can be prohibited outright. "The insurance denied it" is not a sufficient basis, because the reason for the denial is what decides.

Step five: write it off properly

Record it under an administrative-error category rather than general bad debt. That is what makes the total visible, and the total is the argument for fixing the process that produced it.