Top Reasons for Insurance Claim Denials and What You Can do After

Top Reasons for Insurance Claim Denials and What You Can do After

April 27, 2022

Ellis Law Corporation

Personal Injury

If you have filed an insurance claim that has been denied, it can be incredibly scary and frustrating. You may have significant medical expenses to pay, lost income from missing work, lost future income from not being able to go back to your job, and other emotional and financial issues. Knowing why the insurance company may have denied your claim and what steps you can take to rectify the situation is important.

The most commons reasons an insurance company denies claims include the following:

  • No Pre-certification or Authorization: If your insurance company requires that you obtain a pre-certification or authorization in order to receive services, they will deny your claim if you or your medical provider failed to do obtain that.
  • Duplicate Claims: If an employee submits duplicate claims, it’s possible for it to get denied, even if you as the patient didn’t do anything wrong. Sometimes, this will happen because the employee resubmits the claim instead of following up on the original claim.
  • Improper Coding Issues: If the medical professional and their staff does not code the claim correctly, this could lead to a complete denial.
  • Incorrect or Missing Information: If the medical professional leaves out information or inputs incorrect information, this can have a significant effect on your insurance claim. You could end up having to foot the bill because of their mistake.
  • Lack of Documentation: In many cases, the medical professional will have to show that the care you received was medically necessary. If they fail to do this, your claim will likely be denied.

What to do After Your Claim is Denied

  • Review All Information: Once you find out why your claim was denied, it’s crucial to thoroughly review all of the information regarding your claim. If you’re unclear on what happened with the claim and why it was denied, you should reach out to the insurance company for a better explanation. Once you find out the reason, you can try to correct it or have your medical provider correct the issue.
  • Don’t Give Up: One of the most important seps you can take is to be persistent. Even if you call once and find out the reason for the denial and they say they will fix it, you have to follow up. Insurance companies and medical providers are incredibly busy, and it’s not uncommon for things to fall through the cracks if you’re not on top of them. If they tell you it can’t be fixed, you can also appeal the denial. Calling often and making sure you are doing everything you can to get the claim sorted out is incredibly important.
  • Keep Records: When you call your insurance company to discuss the claim, make sure you always write down the information you were given and write down the name of the person you’re speaking to reference in later calls. Make sure you specifically ask why the claim was denied and take notes.
  • Act Quickly: Make sure you don’t delay when you’re having issues with a claim. If you don’t follow up in a timely manner, you may miss the timeframe to submit additional information or appeal the decision.

If you need help with an insurance claim denial, contact our Los Angeles personal injury lawyers for a free consultation.