10 Reasons Why Your Medical Insurance Claims Will Get Denied

Many times your insurance claims will be denied or rejected. This can fall under three categories:

-Coding mistakes

-Documentation mistakes

-Administrative mistakes

Why might your insurance claim get denied?  There are a plethora of reasons. If you do not agree with any of these reasons for denial as adjudicated by the insurance company, you can file an appeal supported by documentation.

1. The client is no longer covered by the insurance policy

2. The client used an Out-Of-Network (OON) provider

3. A lower level of service was deemed more appropriate

4. There was incomplete claim information

5. The diagnosis and procedure codes were not linked correctly

6. The provider’s service was deemed medically unnecessary

7. No pre-authorization was acquired

8. There were multiple codes used when they should have been included in a bundled service

9. The benefit was not covered by the insurance policy

10. Pre-existing conditions were not covered by the insurance policy

An appeal may be handled by filling out a form, sending in a letter, completing an online appeal process. Whichever you have to do is entirely dependent on the insurance company in question.