Reasons for Medical Claim Denials
What Can Be Done?
Health insurance covers hospital expenses including pre- and post-hospitalization as well as in-patient treatments. Sometimes, health insurance claims will be rejected for certain reasons. Medical review companies can assist in reviewing the medical records of the claimants.
Key reasons for claim denials are – Waiting period involved Pre-existing diseases Inaccurate data Health plan period Exclusions Medically not necessary procedures Absence of documentation Out-of-network provider
Solutions Claimant can go for an internal appeal Appeal can be taken to an independent third party for review
To avoid claim denials Know exactly what is covered Stay compliant with the rules Understand the limits on the benefits Check whether the claimant’s physician is in their health plan’s network
LEGAL SUPPORT IS VITAL IF INSURERS HAVE DENIED THE CLAIM WITHOUT CONDUCTING A PROPER INVESTIGATION.
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