Thank you for the opportunity to help you with your question!
Most of the things your doctor recommends will be covered by your
plan, but some may not. When you have a test or treatment that isn't
covered, or you get a prescription filled for a drug that isn't covered,
your insurance company won't pay the bill. This is often called
"denying the claim." You can still obtain the treatment your doctor
recommended, but you will have to pay for it yourself.
If your insurance company denies your claim, you have the right to
appeal (challenge) the decision. Before you decide to appeal, know your
insurance company's appeal process. This should be discussed in your
plan handbook. Also, ask your doctor for his or her opinion. If your
doctor thinks it's right to make an appeal, he or she may be able to
help you through the process.
Please let me know if you need any clarification. I'm always happy to answer your questions.