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Can an insurance provider deny you for a hospital’s paperwork errors?

On Behalf of | Oct 6, 2022 | Denied Insurance Claims

If you have recently been in an accident or undergone treatment for a medical condition, you may have had to file a claim with your insurance company to cover some or all your expenses. However, insurance companies are often looking for reasons to deny your claim so that they do not have to pay you what they owe you.

Your insurance company may deny your insurance claim due to errors made by health care providers. For example, hospitals often make mistakes when billing a patient for services. These mistakes may include:

  • Entering incorrect patient information.
  • Billing a patient for a test or procedure that was not performed.
  • Billing a patient multiple times for the same procedure.
  • Billing a patient the wrong amount for a service performed (e.g., charging $5,000 instead of $500).
  • Using the wrong code and charging for a more expensive procedure.
  • Failing to enter matching diagnosis and treatment codes.

Disputing an insurance denial based on paperwork errors

Hospitals make mistakes more often than we would like to think. Unfortunately, insurers will sometimes take advantage of these mistakes to avoid paying you the money they owe.

If you find that an insurance company has denied your claim due to an error in the hospital paperwork, it is up to you to prove that your claim was wrongfully denied. If your insurer fails to pay even after the mistake has been fixed, you may file a legal claim against your insurer. You will need to establish that the insurance company violated the terms of your policy, or in other words, committed a breach of contract by failing to pay you what they owe you in a timely manner. You can also establish that the insurance company acted in bad faith by failing to pay for no legitimate reason or unnecessarily delaying payment.

It can be difficult to know when an insurer is denying your claim for no good reason. You may benefit from consulting with an attorney to determine if you have a strong case against your insurer for denying your insurance claim.