Representing People With Denied Insurance Claims

Common reasons health insurers wrongfully deny claims

| Jun 2, 2021 | Insurance

When a person in Oklahoma City has a serious illness, such as a rare form of cancer, they may find that they are not just fighting for their life but also for their pocketbook. A person with a rare form of cancer may need extensive medical care and possibly in-home care both of which can be prohibitively expensive. The matter is only made worse when their health insurer denies their claim. The following are some reasons why health insurance companies wrongfully reject patients’ claims for benefits.

Alleged paperwork errors

Health insurers may reject a claim for benefits citing paperwork errors. For example, they may say that the wrong diagnostic code was submitted. Thankfully, easy fixes are available to resolve this issue. Your physician can fill in missing information or correct a coding error, and then resubmit the claim for approval.

Other common reasons a claim is denied

Insurance companies are ultimately looking out for their bottom line. They may go against the decision of the patient’s doctor and claim the procedure was not medically necessary. They may illegally claim that the medical care received was not compensable due to a pre-existing condition. They may claim that there is a lifetime-benefit cap on the coverage of claims. If a person changes jobs during the course of treatment, their health insurer may wrongfully delay making a decision on the claim. Health insurers may wrongfully claim that the physician treating the patient was out-of-network or that medication prescribed was not FDA-approved for the patient’s illness. Finally, health insurers may deny a claim on the basis that the treatment was not necessary or was unproven.

Resolving a denied claim

Having an important medical claim denied by your health insurer can be incredibly frustrating, especially when you are fighting a serious illness. Fortunately, appeals may be an option to resolve the denied claim. To learn more about denied health insurance claims, feel free to explore our firm’s webpage on this important topic.