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Why are health insurance claims usually denied?

You expect your insurance company to cover the medical care you need to stay healthy. However, claims are often denied, and it can be stressful trying to get to the bottom of a rejected claim when you’re not entirely sure what went wrong. Knowing why denials happen is useful in this case and Nerdwallet.com offers a few reasons why your health insurance claim may not be approved.

The Medical Provider Was Not In-Network

Health maintenance organizations (HMOs) require the insured to pick medical provider within a specified network. Going outside this network can transfer the costs of medical care to you, either fully or in part. While some plans make allowances for out-of-network care, it’s important you fully understand the terms of your insurance contract when picking doctor outside your specific network.

The Treatment Was Covered

Certain types of care may not be covered by a standard health insurance policy. For instance, if you’re in need of oral surgery a conventional dental policy may not be sufficient. All policies have a list of covered procedures and it’s crucial that you’re aware of what is (and isn’t) covered or your risk incurring costs for treatment. If a procedure is covered and your claim was still denied, consider getting legal assistance.

Your Name or Birthdate Are Wrong

Transcription errors can happen and when they do you could be looking at a hefty bill. Even something as simple as a typo can detail your claim, which can be distressing if you're in the midst of a serious illness or injury. Be sure you check documentation carefully in the event of a denied claim. If you see any spelling mistakes or other issues, contact your insurance company so the issue can be rectified.  

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