My health insurance claim was denied – What can I do?

Encountering a denied health insurance claim can be a frustrating experience when you are dealing with a medical condition.  But did you know that that majority of denied claims are the result of an administrative error?  If you experience a denied health insurance claim do not be alarmed, there are many reasons that the claim may have been denied and you can follow these steps to resolve the issue.

Call your insurer’s customer service number

The majority of denied claims are the result of coding or administrative errors. These mistakes can typically be corrected and resolved with a phone call to customer service.  The customer service phone number can be found on the back of your health insurance card.

Call your doctor

If customer service says there are no errors from your insurer, reach out to your doctor. The error may have occurred on their end – they may have entered the wrong code, or written incorrect information. Ask them to review your claim again and resubmit it if there is an error.

Still no luck? Don’t give up yet!

If your claim denial was not due to a coding or administrative error, it was likely because the treatment was deemed not medically necessary. In this situation, consult your doctor to determine why the treatment may have been categorized as unnecessary. They may be able to add more details about your case to the claim to demonstrate why the treatment was medically necessary.

You can also research your insurer’s claim policies on their website to see how they define certain diagnoses and treatments. Share the claim policy with your doctor, as they may be able to fill out the claim in a more specific manner to meet the claim requirements.

My claim is still denied

If you’ve exhausted all your options, and your claim is still denied, speak with your doctor or hospital about setting up a payment plan. Most of us aren’t able to pay massive medical bills in one sum, but healthcare providers are typically flexible and can help coordinate a payment method that works with your budget.

You can also prevent future denied claims by researching your insurer’s policies before undergoing treatment and discussing all of your care options with your doctor.  Ask your doctor to submit a pre-determination to your health insurer to find out if the service will be covered.

Want to learn more about health insurance claims? To ask questions and see answers, visit Health Insurance Central

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