6 Ways to Avoid Having a Health Insurance Claim Denied

Health insurance is one of the most important covers that can help an individual with medical expenses at time of health issues. Therefore it is necessary to understand the conditions on which a health claim can be denied and the ways to prevent it. Availing insurance claim advice can help to understand the insured aspects in a policy. Following are 6 ways to prevent the denial of a health claim:

1) Read your health plan

Knowing about the insurance claim is necessary to understand the minutes of the policy. This will help in availing the insurance policy cover needed for specific treatments and health conditions.  Insurance plans sometimes cover only specific medical ailments and excludes coverage for treatments like dental health and infertility operations. Hence understanding the terms and conditions of a policy are essential.

2) Know the maximum cover limit

To avoid the denial of a health claim, always know the coverage limit of policy, the conditions applicable for coverage and the time frame of the policy. Proper knowledge or help will shed some light on the maximum cover that a health insurance can get; this in turn helps with the medical expenses in the hour of crisis.

3) Transcription errors

Make sure to avoid transcription errors while applying for a policy and while making a claim. Spelling mistakes in name, health codes, date of birth, name of dependent/employer/spouse/, etc. can lead to delay and sometimes denial of the health policy. Insurance companies will withhold the procedure in such cases when there is a conflict in the policy documents vs. the information provided in the claim.

4) Pre-authorization

Proper referrals and pre-authorization from different medical agencies, hospitals and doctors are sometimes necessary to avail a claim on that particular medical treatment. Failure to produce written authorization like CT scans and MRIs, at times, can lead to the denial of insurance claim help.

5) Case specific rejection

Treatment received due to automobile accident or occupational hazards may be rejected by the insurance company as it is a part of the employer’s insurance cover. Moreover seeking insurance claim advice, in case of multiple health insurance policies, can help to understand the conditions for a claim.

6) Choose an agent you know

Acquiring help from an out-of-network provider can lead to denial of a health insurance claim. This happens because the terms of the company can/ may be different from what the provider/ agent has agreed to offer.

Following the above simple steps can prevent the denial of a health insurance claim. Consulting with different insurance companies and financial aggregators will help in getting the complete picture while making an insurance claim.