To remain professionally viable, CRNAs must receive fair and adequate reimbursement for services rendered. Denial of payment by third party insurers can result in frustration, loss of income, and potential negative impact on the right to practice. The insurance industry and other health care organizations categorically and conditionally deny reimbursement for a variety of reasons. Categorical denial is the greatest threat to practice. Conditional denial can usually be resolved. When discussing issues with insurers it is important to deal with those in a position to make or influence policy. It is important for individuals and their respective state associations to be familiar with pertinent insurance laws and regulations because they identify practitioner rights and claims that can be made against the insurer. Any categorical denial should be brought to the state association's attention and investigated for possible illegal action.