Avoid Denials When You File Your Health Insurance Claim
Insurance has turned out to be a vital resource for the individuals
, since the coverage benefits can aid the policyholder at the oddest hours. Protecting your health with insurance is one of the most sensible steps that you can take. If a health insurance policy is bought at the right time, it enables the policyholder to undergo all the necessary medical treatments that he/she might not have been able to afford.Nevertheless, there are times when a health insurer denies coverage. Feeling dismayed at the rejection won't help at this point. You'll need to gear up for yourself and approach your insurer directly to find answers to insurance questions. After all, you need to know why your claim has been denied.
Reasons for health insurance denial
The possible reasons for which a health insurer can deny coverage are enumerated below:
Unnecessary treatments If the insurance company finds that the medical treatments for which you have made the claim are unnecessary for the patient, it will deny paying for the expenses. The routine medical check-ups are not questioned. Surgeries done for reconstructive purposes after an accident will also be covered. However, the insurer won't be paying for the medical expenses done for the beautification like a nose-job or cosmetic surgery etc.
Incorrect or insufficient information -The insurance company may also deny payment for the claim if they find that the information you have provided is either incorrect or insufficient for the process. You'll need to send in details of the medical treatments that the patient has undergone and the reasons for which they were necessary. The insurance company will evaluate the authenticity, and then only forward the payments. If any discrepancy in the information is uncovered, your claim will be denied outright.
Pre-existing conditions -Insurance companies usually investigate the medical history of every insured individual thoroughly. If the claim is filed within 2 years of buying the policy and your insurer finds any valid reason to believe that the medical condition, for which you might have undergone treatment, was existent before you opted for the coverage, your claim will be denied.
Plan exclusions - Many health insurance plans maintain lists of medical services as policy exclusions. Experimental surgeries, infertility treatments etc might not be covered by your health insurance plan, and thus claims made for such treatments might be denied straight out. Again, certain HMO plan enlists specialists within its network for your medical treatments. Your claim might be denied if you get your treatments done from anyone outside the network. Thus, before making a claim, you must read your policy documents carefully.
Lack of pre-authorization or referrals - Many health insurers ask for pre-authorization of services or referrals from doctors, for specific treatments. This is especially applicable for the non-emergency and non-standard or experimental services. Failure to provide the same, in time, may result in claim denials.
You don't need to lose heart, once your health insurance claim is denied. You can file an appeal with the company and ask for re-consideration. However, it's wise to avoid facing a rejection in the first place. Search answers to insurance questions, to understand all about your coverage and the claim process, at the time of buying your health insurance policy.
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