• 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



Patrick D. Souter

Patrick D. Souter

Gray Reed & McGraw LLP

  • Of Counsel, Gray Reed & McGraw LLP
  • Represents physicians, hospitals, and ancillary providers in operational, regulatory, and administrative matters
  • Board Certified in healthcare law by the Texas Board of Legal Specialization
  • Adjunct Professor of healthcare studies at Baylor University School of Law and the Baylor University Hankamer School of Business’ Robbins Institute for Health Policy and Leadership
  • Frequent speaker to national and local healthcare organizations on physician, hospital, and other provider issues
  • Recognized as a leading healthcare lawyer in Texas by Chambers & Partners USA and selected by his peers for inclusion in Woodward/White, Inc.’s The Best Lawyers in America in the field of healthcare law
  • 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- 2022 Editions) and What is ... Medical Staff Peer Review?
  • Member of the American Bar Association, Fellow of the American Bar Foundation, 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; B.B.A. degree in finance, Baylor University Hankamer School of Business
  • Can be contacted at [email protected], 214-954-4135, or 1601 Elm Street, Suite 4600, Dallas, TX 75201

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