5 Reasons Health Insurance Claims Get Denied & How to Avoid Them

Introduction

Mediclaim policy gets rejected? Anyone can find this terrifying. Now imagine if your Mediclaim policy gets rejected and you have to pay for the treatment out of pocket. 

We all have an idea about how incompetent the process of claim filing can be and sometimes denial follows up, as a result leaving us frustrated with diminishing bank balances. 

Health insurance paperwork is daunting enough to tackle when you’re already sick, but filing an out-of-network claim can be even more of a headache.You have to file a health insurance claim when you want your medical expenses paid. 

Additionally, it puts a financial burden on the insured and his family. Here are the reasons why a health insurance claim gets rejected.

Reasons Health Insurance Claims Get Denied

1. Incomplete or Incorrect Information

One of the most common reasons health insurance claims get denied is due to incomplete or incorrect information. This can include errors in personal details, incorrect policy numbers, or missing documentation.

How to Avoid

Make sure you double-check your forms before submitting them. Make sure all the fields are filled out correctly and include all the paperwork. Keep a checklist so you don’t make the same mistakes again.

Additional Tips

Verify the information with your insurance provider. It can save you from possible denials if you catch any issues early.

2. Lack of Pre-authorization

Many insurance plans require preauthorization for certain procedures or treatments. Failing to obtain this preauthorization can result in claim denials.

How to Avoid

Always review your insurance policy to understand which treatments require pre-authorization. Communicate with your healthcare provider to ensure they submit the necessary requests on your behalf.

Additional Tips

Keep a record of all communications with your insurance company regarding pre-authorizations. This documentation can be valuable if you need to dispute a denial.

3. Out-of-Network Providers

Using healthcare providers that are not within your insurance network can lead to higher out-of-pocket costs and potential claim denials.

How to Avoid

Before you schedule an appointment or procedure, check your insurance provider’s network directory. If possible, use in-network providers to avoid surprises.

Additional Tips

If you need to visit an out-of-network provider, contact your insurance company in advance to find out which costs will be covered and what documentation will be needed.

4. Excluded Services or Treatments

Insurance policies frequently include a list of services or treatments that are not covered, known as exclusions. If you submit claims for these excluded items, they will likely be denied.

How to Avoid

To avoid this, it’s important to become familiar with the list of exclusions in your insurance policy. Before undergoing any treatment, it’s recommended to confirm with your insurance company if it is covered under your policy

Additional Tips:

If you find that a necessary treatment is excluded, consider discussing alternative options with your healthcare provider that may be covered by your insurance.

5. Missed Deadlines

Don’t forget, each insurance policy has its own deadlines for submitting claims. If you miss these deadlines, your claim will definitely get denied.

How to Avoid:

Be proactive in managing deadlines for your insurance claims. Take charge by setting reminders and noting important dates on your calendar to guarantee that you meet all submission deadlines.

Additional Tips:

If you’re not sure about a deadline, just reach out to your insurance provider to double-check. It’s better to ask and be sure than to miss out because of a simple oversight.

Things to Consider While Filing Medical Health Insurance Claim

It is very important to choose the right health insurance plan from the start, that can prevent many issues and ensure you get the coverage you need when you need it most.

• Make sure to check if your health insurance covers the medical service or treatment before you submit the claim.
• Make sure you know your insurance policy inside out – understand the terms, conditions, and what’s not covered to avoid any surprises.
• Don’t forget to gather all the paperwork you’ll need, like medical bills, receipts, and treatment records, to back up your claim.
• Don’t forget to submit accurate information: Make sure all claim forms are filled out completely and accurately to avoid any delays or denials.
• Don’t forget to keep copies of all the stuff you send in and any emails you get back. This way you’ll have everything handy if you need it later.
• Don’t forget to keep an eye on your claim status and reach out to the insurance company if there are any delays or problems.

Conclusion

Dealing with health insurance claims can be tough, but if you know the common reasons for denials and take steps to avoid them, it can be much easier. 

Make sure all the info is complete and accurate, get any needed pre-authorizations, use in-network providers, stay away from services not covered, and meet all the deadlines.

Doing these things can really lower the chances of your health insurance claims getting denied. Remember, staying informed and organized is the key to handling health insurance claims well.

Disclaimers: The above information is for reference purposes only: Policy Assurance and Claims at the underwriter’s discretion.