3 Common Reasons Why Your Health Insurance Claim Might Be Denied

21 March 2016
 Categories: , Blog


In addition to being sick or injured, one of the worst things that can happen revolving around your health related issue is having your health insurance claim denied. Sometimes you will have some of your medical bill covered, and sometimes none of it at all. Throughout the course of this brief guide, you will learn a few of the common reasons why you will receive only partial coverage, or none at all.

The Wrong Company Was Billed

This may seem like a silly reason, but this is an issue that occurs. Several things might serve as an explanation for this issue. One, the hospital or your physician's office may have billed the wrong insurance company. Secondly, your current insurance company may have outdated information on your file, leading to this error. It may also be the case that you simply have forgotten that you do not have an active policy open with the provider that you billed. Sometimes a person will have double coverage – such as being covered by your own employer and your spouse's employer – that will lead to the hospital or doctor's office billing the wrong provider.

Procedure Not Covered

You may have been denied because your policy does not have coverage on the health related procedure in question. It is important to look at the terms of the policy before submitting your insurance information to the hospital. There are a number of issues that are often times not covered by a health insurance policy, including dental surgery, infertility treatments, and cosmetic surgery that does not treat any known substantive issue regarding your health. It is important to discover a policy that is comprehensive, yet within your budget, such that your claims will be accepted.

Transcription Errors

When providing information to your provider, both you and your doctor's office will have to remain diligent about filling out the absolute correct data. Small typos on documents can lead to your coverage being denied. Things that may seem pedantic to you, such as your surname being misspelled or your date of birth being entered incorrectly, are simply a way to prevent fraud from occurring and ensure that these issues will not lead to identity theft.

Having an insurance claim denied may seem like a very large issue, but sometimes the problem can be chalked up to a very minor error on your behalf. Hopefully, this brief guide has given you some idea of some of the reasons why your claim was denied. To learn more, contact an insurance company like W B Adams Co


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