Common Reasons Why a Healthcare Claim Is Denied
- Seeking treatment without authorization
- Making mistakes in claim filing
- Filing healthcare insurance claims outside time limits
- Getting treatment or medical services not covered by the healthcare policy
- Opting for medical procedures that are not necessary
When Should You File a Health Insurance Claim?
Insurance companies watch the bottom line and keep an eye out for fraudulent health insurance claims. To avoid having your healthcare claims denied, make sure the medical service, procedure or treatment you seek is recommended and authorized by your primary care physician or a doctor you have been referred to for care by your doctor or clinic staff.
The typical times when you may need to file a health insurance claim are when you are sick or injured, when you have a procedure done that your physician has prescribed, or a family member is sick, injured, or needs surgery. You may also need to file a claim if you need urgent care services outside of regular clinic hours.
Be sure to coordinate with your health insurance company representative before any care or procedure, whenever possible, to determine which aspects of your medical treatment are covered.