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Reasons For Denials Of Health Insurance Claims

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Reasons For Denials Of Health Insurance Claims

Reasons For Denials Of Health Insurance Claims

Nowadays, for an individual having health insurance policy of their own has to remain wary about any denial of claims. The claims getting denial could be for the right kind of treatment, preauthorization and necessary steps that have to be undertaken for the treatment. There are numerous reasons for denials of health insurance claims by the insurance providers.

Reasons For Denials Of Health Insurance Claims

It has been found that the commonest reason for any claim to be denied by any health insurance company is the simple fact that no coverage is available for the procedure, pharmaceutical or preparation. The best thing to do for not getting claim denials is to go through the recent version of the health insurance policy that will help to know better about things which come under coverage. By doing so, one can buy the most recent health insurance policy. It needs mentioning that most of the policies have undergone numerous changes in the last few years that have led to financial burden on the policy holder.

One can also talk someone specializing in the treatment that is meted out to the patient. This kind of specialist is available with the health insurance provider. It is better to ask questions freely to the person about the things that cannot be covered in the policy that is purchased. Make sure to write down the name and telephone number of the person before the conversation starts. Keep complete notes of every step and don't forget to keep relevant papers, whatever be its importance.

Keep a detail note of the steps that are undertaken while availing treatment. These include the time of requesting pre-authorization, receipt and the source. Note the treatment date and the issues of discussion with the doctor, the actions that were undertaken and the follow-ups that are necessary.

There are good numbers of mistakes done while processing claims. A study conducted by Health Insurance Plans of America has come out with the startling fact that 14 percent of all submitted claims to the insurance providers are finally rejected. The study also claims that for every seven claims, one needs re-submission as well as re-processing as a result of some errors made in the original claim. This is undoubtedly a costly affair for the policyholder.

It is good idea to do research on the laws of the state in respect of things that could come under claim coverage and also what are considered as “arbitrary” things. By doing this, one can bring to notice to the insurance company about what should be considered as “medical necessity” and also the billable requirements.

It must be confirmed that the insurance provider as well as the office of the doctor are in contact among themselves and the necessary paperwork are tendered with each other. If the company where the policyholder is working is paying the coverage in full or in part, it would be right to inform the human resources department about the situation. This way the department can deal with paperwork that the policy holder is not able to manage.


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