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Tips for avoiding a health insurance claim denial

On Behalf of | Nov 7, 2018 | Insurance Law |

Medical expenses are one of the leading causes of consumer debt for residents of Washington and the rest of the nation, and in some cases, patients face far higher bills than they anticipated. In some cases, patients mistakenly believe that their health insurance companies will cover certain procedures or treatments, but they soon find out their insurers have no plans to do so, leaving them on the hook, financially, for considerable amounts. At the Lepley Law Firm, we recognize that many insurers deny health insurance claims for similar reasons, and learning what those reasons are may help you avoid having your own claim denied.

According to NerdWallet, one of the most common reasons insurance companies deny health insurance claims is because patients use out-of-network health care providers. Essentially, this means you elected to receive treatment from a medical provider who has not agreed to your insurer’s terms, and your insurer can deny your claim because you did so. The easiest way to avoid this is to stick strictly with in-network health care providers.

Many patients also receive denials in response to their health care claims because they undergo procedures or treatments without making sure their insurers covered said procedures and treatments. For example, some providers do not cover treatment relating to infertility, so you need to determine whether yours covers the specific type of treatment you need before getting it.

Yet another common reason health insurance companies deny patient claims is because your doctor failed to get preauthorization for a particular procedure. Certain treatments require preauthorization, and while, sometimes, you may not be able to have a particular procedure performed without preauthorization, in others, you may not find out you needed preauthorization until you receive a denial in response to your claim. Find more on this subject on our webpage.