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What Are the Most Common Reasons Why Health Insurance Claims Are Denied?

April 1, 2021

Many people might be surprised to hear that medical bills are one of the leading causes of bankruptcy in the United States. It is important for everyone to make sure they have a firm plan in place in the event of an emergency medical expense. That is for health insurance can be helpful. Health insurance is used to help people cover the costs of medical care. Of course, there are plenty of health insurance plans out there. Therefore, it is important for everyone to find the right medical plan for them. That is where a small business health insurance broker can help.

Sadly, some health insurance claims are denied. What are some of the most common reasons why health insurance claims could be denied?

The Claims Are Not Covered Under the Plan

One of the most common reasons why health insurance claims could be denied is that that specific expense is not covered under the current plan. For example, some people have health insurance plans that only cover their bills in the event of a catastrophic injury or illness. These types of plans may not cover preventive health care. Or, there are certain health insurance plans that may only cover someone in a specific geographic location. If the bill was incurred outside that geographic location, it may not be covered. For this reason, it is critical for everyone to read their health insurance plan carefully. That way, they can maximize our chances of their expenses being covered.

Another Diagnostic or Treatment Option Was Available

In some situations, health insurance plans may not cover that specific cost if there were cheaper diagnostic or treatment options available. And a lot of situations, health insurance companies will ask doctors to perform certain tasks or try certain treatments before they move to more expensive options. If this was not followed, the health insurance claim could be denied. Again, it is critical for everyone to make sure their doctor is familiar with their health insurance plans. This is important for making sure that patients who are receiving medical care do not have to pay for diagnostic and treatment options that are not covered. If the health insurance provider asks for a less expensive option to be tried first, the doctor may need to try that first. Or, patients can ask doctors to speak to the insurance company directly to try to confirm something is covered before that run that test or try that treatment.

Read the Health Insurance Plan Carefully

These are just a few of the many reasons why certain health insurance claims could be denied. Sadly, a lot of people have to file for bankruptcy because of unexpected medical expenses that may not be covered by health insurance. Furthermore, this is a situation that could be avoidable. It is critical for everyone to read their health insurance plan carefully. Health insurance should help people cover their medical bills, not add to them.

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About Me

Hello all!!!! I'm Darcy and I recently started writing on My Zeo about health and fitness (and part of that important health equation is sleep!). As we are all super busy with life, I try to integrate how to stay fit, relax and be healthy and happy through everyday life.

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