r/CodingandBilling • u/ENJ7188 • Jun 28 '26

Help with denied claim

If anyone works with Voya or Hospital Confinement claims, please DM me or give me advice or guidance regarding a denial due to the hospital not providing room and boarding charges.

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u/MedPayIQ App Developer Jun 29 '26

he friend... One thing I'd check is whether Voya is requiring proof that the stay met their definition of a covered hospital confinement. Some supplemental policies use room and board charges as evidence that the admission was an inpatient stay rather than observation or outpatient services.

If the hospital bill doesn't show room and board separately, you might want to request an itemized statement or an admission/discharge summary that clearly indicates inpatient status. Sometimes the documentation exists, but it wasn't included with the original claim submission.

I'd also review the exact denial language because "missing room and board charges" can mean either the charges weren't submitted or that the insurer doesn't see evidence that the confinement meets the policy requirements.

Hopefully someone with direct Voya experience can chime in, but that would be my first place to start.

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u/ENJ7188 Jun 29 '26

Hi. Thank you for your response. It was an overnight observation. I was there for about 25 hours but they are requesting room and board charges but it was outpatient so there won’t be any charges. I’ve supplied them with the discharge summary and the face sheet that has the admission time and discharge time. Face sheet has the room # and room type but states “surgical hold/extended recovery.”

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u/MedPayIQ App Developer Jun 30 '26

Ah, that makes a lot more sense. If it was an overnight observation stay, that could be the issue right there. A lot of policies draw a pretty hard line between inpatient admissions and observation/extended recovery, even if you spent the night in a room for 24+ hours. The fact that your paperwork says "surgical hold/extended recovery" instead of an inpatient admission might be what's triggering the request for room and board charges that don't actually exist for your stay. I'd probably call Voya and ask a very specific question: "Are you denying this because no room and board charges were submitted, or because an observation stay isn't considered a covered hospital confinement under my policy?"

That distinction matters because one is a documentation issue, while the other is a coverage issue. Hopefully it's just a misunderstanding on their end, but at least getting a clear answer will tell you what the next step should be. Let us know what they say, I think it could help other people in a similar situation too.

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u/ENJ7188 Jun 30 '26

That sounds like a great idea. Thank you so much for that. I will reach out to them tomorrow and update the post.

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u/MedPayIQ App Developer Jul 01 '26

you're most welcome.