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Common reasons why health insurance denies claims

On Behalf of | Dec 28, 2020 | Insurance

Getting into an accident or suffering a medical emergency can be physically and emotionally painful. However, some Oklahoma residents later suffer the secondary pain of a denied health insurance claim when their insurer elects not to provide coverage for their treatment and care. The grounds for health insurance claim denials can be extensive.

This post will discuss some of the common reasons that health insurers deny claims. Its contents are not comprehensive, and no part of this post should be read as legal advice. Individuals who are struggling with denied insurance claims can contact trusted insurance attorneys in Oklahoma City for support.

Denied health insurance claims: Common bases

Health insurance claims can be denied for substantive or technical reasons. Some of those reasons include:

  • Treatment was sought from an out-of-network provider
  • Treatment required authorization or a referral
  • Treatment was deemed unnecessary or experimental
  • Insurance paperwork had errors or typos
  • Insurance claim was received too late
  • Treatment was not covered in the scope of policy

Many bases for denied health insurance claims can be fixed and resubmitted for review by insurers. An individual who is unsure of how to proceed with their denied claim can always contact an insurance attorney for guidance.

Appeals and beyond for denied health insurance claims

Responding to a letter of denied coverage can be overwhelming, but individuals have the right to do so as part of the insurance denial appeals process. It is possible for an insurer to overturn their decision when a policy holder makes a strong, fact-driven argument on appeal. When an insurer does not reverse a coverage decision, though, an individual may have to take different legal steps.

Litigation is an option for some who are facing denied health insurance claims. A lawsuit is a significant legal filing that requires attention to timeliness and detail. Legal counsel can be of great value to those whose denied health insurance claims reach this level of review.