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Common reasons health insurance claims are denied

On Behalf of | Feb 26, 2021 | Denied Insurance Claims

Without health insurance, many Oklahoma residents would most likely not be able to afford medical treatment. This is why it can be especially frustrating if a health insurance claim is denied. When that happens, it is likely one will have to fight for their rights. The first step in doing that is finding out why the claim was denied.

Why could a claim be denied?

A denied claim is not the end of the road. Many times, it is possible to fix the paperwork error and file an appeal. Below are common reasons health insurance claims are denied:

  • Medical billing errors or incomplete information provided in the original form;
  • The procedure is either not medical necessary or not covered by health insurance;
  • Coverage limits may have already been exceeded; or
  • Rather than use in-network providers, out of network providers may have been used.

Denied claims are not rejected claims

A denied claim is different from a rejected one. A denied claim is one that has been processed and approved for a specific reason. A rejected one is one that has not even been processed, because of some mistakes made when filing. While it is possible to appeal a denied claim, it is not possible to appeal a rejected one.

Insurance companies send denial notices when a claim is denied. This notice will contain the reason the claim was denied and how long one has to appeal. This time limit is important; any appeal filed after this time will not be entertained.

It might not be possible to appeal every denied claim, depending on the reason it was denied. However, if someone believes there was a mistake with their case, it might be beneficial to consult an experienced attorney to discuss one’s options and how to take advantage of the right to appeal.