Objective: The study analyzes the current status and influencing factors of medical insurance refusal of payment for ultrasound examination fees, and puts forward targeted suggestions. Methods: Based on the data of medical insurance claim denials for ultrasound examination at a tertiary hospital in Zhejiang Province from 2023 to 2024, this study analyzed the reasons for claim rejections by applying descriptive statistical methods, in accordance with the current medical insurance reimbursement policies for ultrasound examination in Zhejiang Province. Results: Overall, the medical insurance payment compliance rate for each age group showed the characteristics of high rates in the low age group (0,14], low rates in the young-adult age group (14,40], an increasing trend in the middle-aged and old-aged age group (40,70], and low rates in the high-age group (70,100]. Additionally, the overall compliance rates of general outpatient clinics were the lowest. In-depth analysis revealed that the higher the number of examinations of the same item on the same day, the lower the payment rate. The non-oncology patient over-frequency, double billing and over-examined sites were the main reasons for denial of payment. Conclusion: We propose to optimize medical insurance reimbursement policies, standardize medical practices, and enhance hospital management empowerment to coordinate the healthcare service undertakings containing patients, medical insurance systems, and healthcare institutions, thereby promoting high-quality development in the healthcare sector.