February 25, 2024

Patients Beware! 8 Reasons Why Your Medical Claim was Denied By Your Insurance Company

  • December 28, 2016
  • 3 min read
Patients Beware! 8 Reasons Why Your Medical Claim was Denied By Your Insurance Company

Healthcare is expensive. To get the best medical services if and when you fall ill, you will apply and pay for insurance. This protects you. Unfortunately, there are incidences where you will not receive your health insurance claim; even after paying annual or monthly premiums. These reasons include:

Services rendered aren’t covered

Most of the time, you will find that there are services that the medical insurer will not cover. Though not highlighted in bigger fonts, you should be able to see them if you go through your policy before signing.

Failure to read these policies and agreements means that you will visit a medical facility ignorant and after receipt of services, your insurance refuses to pay your claim. Some of these services include lenses, vision exams, supplies, and glasses. Infertility treatments may not be covered as well. Always check your policy and if you will need the services later, shop for a new policy.

Maximum exceeded

If your insurance policy or the benefit plan selected has a maximum on the number of times a particular service is provided, then you will not be covered when you exceed that maximum number.

There is a discount that is given by insurance companies. You can still ask the insurance company for this if the maximum has been exceeded.

A preauthorization wasn’t given

Your insurance company needs to receive and approve a preauthorization request for procedures like MRIs or CT scans. This is supposed to be filed or requested by the doctor. If there is no preauthorization request approved before the process, then you will be denied your insurance claim.

Transcription errors

Misspelt names and dates etc. means that the wrong information isn’t submitted to the insurance company and the request for a claim is automatically denied. This isn’t your problem as the patient. Your doctor should resolve the problem and find a permanent solution to the recurrence of such incidences in future.

Incorrect Personal Identification Number

Without the correct PIN, the insurance company will not process and authorize disbursement to the hospital for your medical case. Identity problems are averted by counter-checking identification information with formal copies of the documents.

Untimely filing

If the insurance company gets your medical claim late after your release from the hospital, you claim may be denied. If you submit your insurance documents late, the insurer will deny to process it because of insufficient processing time and lack of authorization.

Cosmetic procedures

If the procedure performed on you was wholly cosmetic, then you will not be covered by the insurance company. About all insurance companies refuse to offer insurance covers for cosmetic procedures. If that is your case, then you should know beforehand that you will pay for the procedure out of pocket.

Termination of the cover

It is important that your insurance information is verified before you undergo a procedure or receive treatment. Verified insurance information will alert the medic or the administrator of the termination. If this isn’t done, you will be denied the medical claim.  

term insurance plan

In conclusion, as a patient, you have the responsibility of ensuring that you have the right information sent to the insurance company. Most of these denials result from your inability to relay the correct information early or not reading the policy thoroughly. Be careful about the little notes in your policy.

Author bio

Melanie Brooks is a medical billing expert at a leading medical practice. She uses the anesthesia services for billing and recommends that patients be cautious to avoid avoidable cases of insurance denial.

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