Reasons Your Health Insurance Claim Might Be Denied

Unfortunately, accidents happen and things don’t always go as planned. An insurance claim that's denied only adds to the frustration of an already difficult situation. People end up in predicaments like this all the time, but why and how?

While some claims are denied in bad faith, there are many reasons why a health insurance claim may be denied with just cause. The bad faith insurance lawyers at Millin & Millin are here to present these key factors so that you’re prepared no matter what.

The Most Common Justifications for Insurance Claims To Be Denied

Though the specific details of each case differ, there are a few reasons frequently cited which can cause someone’s health insurance claim to wind up denied. Let’s explore some of these in greater detail:

• • Lack of Coverage – If your insurance plan doesn’t cover what you claim, then your claim won’t be accepted. This is usually the case for “unnecessary” surgeries, procedures/medications not covered by the FDA, or therapies not deemed “essential.” Be sure to research the key details of what your plan does and does not cover!
• • Maxed-Out Coverage – Many insurance plans come with terms known as “coverage limits.” If you have exceeded the limits of what your plan covers, you will most likely be denied

• • Billing Errors – Sometimes the submitted claim documents are either unfinished or lack information. Additionally, there could be medical billing errors, such as having the wrong provider info on file or incorrect information.

• • Remain “In-Network” – Finally, if you attempted to use your health insurance out of state or outside of services provided by your network, the claim may be denied on those grounds.

Of course, you’re always able to appeal, and the company must cover your medical expenses if you succeed. If bad faith is involved, you may need the help of legal counsel.

Reasons Insurance Claims Are Denied and What To Do Next

Take it from the professional bad faith insurance lawyers at Millin and Millin, it’s vital to know what you’re covered for and why insurance claims are denied. If you’ve been denied in bad faith, reach out to our office to take the first steps to set things right!

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