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  • 14 minutes

Introduction to Medical Denials


What is a medical denial?

A medical denial is an adverse payor determination for any type of health benefits coverage or reimbursement. It may be for the preauthorization of a product or service or a denial of a claim for reimbursement for the product or service provided. Applies to any type of payor and payor program and may be the end result of an investigation, audit or recoupment action. This video reviews when the appeals rights are triggered and discusses how a denied party should approach a denial.

Runtime: 14 minutes
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Patrick D. Souter

Patrick D. Souter

Gray Reed & McGraw LLP

  • Of Counsel, Gray Reed & McGraw LLP
  • Representation of physicians, hospitals, and ancillary providers in operational, regulatory, and administrative matters
  • Board certified in health care law by the Texas Board of Legal Specialization
  • Adjunct professor of health care studies at Baylor University School of Law and frequent speaker to national and local health care organizations
  • Recognized as a leading health care lawyer in Texas by Chambers & Partners USA (2020) and selected by his peers for inclusion in Woodward/White, Inc.'s The Best Lawyers in America in the field of health care law (2019 - 2021)
  • Frequent author of books and articles for the American Health Law Association (AHLA) and American Bar Association (ABA) including co-authoring the AHLA’s Representing Physicians, 4th edition and the ABA’s Physician Law Evolving Trends and Hot Topics (2017- 2020 editions) and What is ... Medical Staff Peer Review?
  • Frequent speaker on physician, hospital, and other provider issues
  • Member of the American Bar Association, State Bar of Texas, American Health Law Association, American College of Healthcare Executives, and Health Care Compliance Association
  • LL.M. degree in health law, Hofstra University; J.D. degree, Baylor University School of Law; M.B.A. degree in health services management, University of Dallas
  • Can be contacted at 214-954-4135, [email protected] or 1601 Elm Street, Suite 4600, Dallas, Texas 75201
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