Mental health care in America faces a growing problem. Many people who need help today cannot get it. Insurance denials are common, especially for same-day services, leaving patients unable to get immediate help. This leaves patients in crisis without proper care.
The issue affects more than 1 in 5 American adults each year. When someone reaches out for mental health support, timing matters greatly. A person in crisis cannot always wait days or weeks for approval. Yet the system frequently forces them to do exactly that.
This blog explains what same-day denials are, why they happen, and how they affect people.
What Are Same-Day Service Denials?
Same-day service denials happen when insurance providers refuse to cover mental health treatment on the day it occurs. A patient might visit a therapist, counselor, or psychiatrist expecting their insurance to pay. Instead, they receive a denial notice days or weeks later.
These denials create serious barriers to care. People seeking help for anxiety, depression, or crises need immediate attention. When insurance companies reject these urgent visits, patients face difficult choices.
Some cannot afford to pay out of pocket. Others avoid getting help altogether because they fear the financial burden. Either way, the denial prevents necessary treatment.
Why Do Payers Deny These Claims?
Most payers have strict rules about billing for multiple services delivered on one visit. They may consider overlapping codes “duplicate” or view the second claim as unnecessary. Common reasons include:
- System edits: The payer’s system flags claims with the same date and the same provider ID.
- Code conflicts: Certain CPT or HCPCS codes can’t be billed together under payer policy.
- Coverage limits: The payer might only cover one mental health service per day.
- Documentation issues: Notes might lack distinct time logs, session details, or justification for dual services.
These rules often vary by payer, making compliance tricky for behavioral health providers.
Common Examples in Mental Health Settings
Same-day denials often occur in integrated or collaborative care settings, where mental and physical health teams share patients. Let’s look at common cases.
Therapy and Medication Management on the Same Day
Psychiatrists who provide both evaluation and psychotherapy might find the therapy claim denied. Some payers consider these services overlapping unless distinct documentation supports each component.
Behavioral Therapy and Group Sessions
If a therapist provides an individual counseling session and then leads a group session for the same person, one claim may get rejected due to same-day conflicts.
Mental Health and Primary Care on the Same Day
In integrated clinics, a patient may see both a behavioral health specialist and a primary care doctor. Some payers don’t allow two different providers to bill for the same diagnosis on the same day, even though both services are necessary.
The Denial Impact on Patients
Same-day service denials create real harm for people seeking mental health care. The consequences extend far beyond simple inconvenience.
Financial Burden
When insurance denies a claim, patients receive the full bill. Mental health services can cost hundreds or thousands of dollars. Many people cannot afford these unexpected expenses.
Some patients enter payment plans that last for years. Others see their credit scores damaged. The financial stress itself worsens mental health conditions, creating a vicious cycle.
Delayed Treatment
Fear of rejection makes people hesitate to seek help. They wonder if their insurance will cover the visit. This hesitation can turn a manageable problem into a serious crisis. Some individuals wait until their symptoms become unbearable. By then, they need more intensive and costly treatment. Early intervention could have prevented this escalation.
Loss of Trust
Repeated denials erode trust in the healthcare system. Patients feel betrayed when their insurance fails to cover needed care. They may stop seeking treatment altogether. This loss of trust affects recovery. Mental health improvement requires consistent engagement with providers. When people avoid care due to denial fears, they cannot make progress.
Worsening Conditions
Untreated mental health problems rarely improve on their own. Without timely intervention, conditions like depression and anxiety grow more severe. Some patients develop additional complications. The delay caused by denials can have tragic outcomes. Suicide risk increases when people cannot access crisis services. Every denied same-day visit represents a missed opportunity to save a life.
How to Fight a Same-Day Service Denial
Patients have options when their insurance denies a mental health claim. Taking action improves the chances of overturning the decision.
Review the Denial Letter
- The denial notice should explain why the insurer rejected the claim. Read this carefully. Look for specific reasons cited.
- Common denial reasons include lack of prior authorization, out-of-network provider, or lack of medical necessity. Understanding the stated reason guides your appeal strategy.
Gather Supporting Documents
- Collect all records related to the denied service. This includes receipts, clinical notes, and correspondence with your provider. Your therapist or doctor can help obtain clinical documentation.
- Strong documentation proves the medical necessity of your visit. Notes describing your symptoms and the provider’s assessment carry significant weight.
File an Internal Appeal
- Insurance companies must allow you to appeal denials. Start with an internal appeal to the insurer itself. Submit your appeal in writing within the timeframe specified in your denial letter.
- Explain why you believe the service was necessary and should be covered. Include supporting documentation. Reference your policy’s coverage terms and any applicable laws.
Request an External Review
- If the internal appeal fails, request an external review. An independent third party will examine your case. This reviewer has no financial interest in denying your claim.
- External reviews often result in overturned denials. The process is free for patients in most states.
Seek Legal Help
- Consumer advocacy organizations and legal aid societies sometimes assist with insurance denials. They can provide guidance or representation at no cost.
- An attorney specializing in healthcare law can also help, though this option involves expense. For large denied claims, legal representation may be worthwhile.
Contact Your State’s Insurance Department
- Every state has a department that regulates insurance companies. Filing a complaint creates a record of the insurer’s behavior. Regulators may investigate companies with patterns of unfair denials.
The Role of Compliance and Training
Strong billing compliance programs reduce risk and ensure ethical claim submission. Staff training remains vital in preventing billing mistakes and maintaining payer trust.
Regular Policy Updates
Insurance policies evolve frequently. Conduct quarterly reviews to update staff on new billing guidelines or changes to CPT codes and coverage.
Internal Audits
Perform internal billing audits every few months. Cross-check same-day claims for accuracy, timing, and proper use of modifiers. Early detection helps avoid payer penalties or take-backs.
Staff Education
Host training sessions for clinicians and billers about same-day service documentation, coding logic, and denial appeal workflows. Clear communication between clinical and billing teams improves claim outcomes.
Conclusion
Mental health needs do not wait. Same-day access can change outcomes. Denials add risk and pain. Improving staffing, easing rules, and using telehealth can do better. If your practice is tired of unpaid claims, same‑day denials, and slow cash flow, now is the time to partner with a focused billing team. Connecticut Medical Billing helps providers clean up claims, reduce denials, and get paid faster so you can focus on patient care instead of paperwork.
FAQs
What is the same-day denial code?
Denial code 231 means that certain procedures cannot be performed on the same day or in the same setting.
What is the same day, same service policy?
The Same Day/Same Service policy applies when multiple E/M or other medical services are reported by physicians in the same group and specialty on the same date of service.
Can a patient see two different doctors on the same day?
Patients often schedule two medical appointments on the same day with physicians of different specialties.