coverage denial
[/ˈkʌvərɪdʒ dɪˈnaɪəl/]
nounpl: coverage denials
negação de cobertura
1. The refusal or rejection by an insurance company to pay for a claim or provide coverage for a specific medical procedure, treatment, or service
The patient received a coverage denial from the insurance company for the experimental treatment.
O paciente recebeu uma negação de cobertura da seguradora para o tratamento experimental.
2. A formal decision by an insurer that a particular claim is not covered under the policy terms
The coverage denial was appealed by the customer after reviewing the policy documentation.
A negação de cobertura foi contestada pelo cliente após revisar a documentação da apólice.
Coverage denials are significant legal and financial matters in both the USA and Brazil. In the US healthcare system, insurance denials are common and often contested through formal appeals. In Brazil, healthcare coverage issues involve both private insurance (seguros de saúde) and the public system (SUS - Sistema Único de Saúde). The term is widely recognized in both legal and medical professional contexts.
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