You might think that having insurance coverage will provide a soft landing when you fall sick, at least financially, but that is not always the case. Instead, you could be in for a nasty surprise when the insurance company denies your claim, leaving you on your own.
Given the rising cost of health care, you might find yourself in financial straits following the denial of your claim, and you need to know the steps to take. The first thing is to understand why your insurer denied your claim. Keep in mind that your insurance policy is your contract.
Why was your claim denied?
The reasons for denial vary on a case-by-case basis. Some of the most common reasons an insurer would deny your claim are:
- Insufficient information on your claim or errors with the paperwork, (including errors in coding)
- The medical procedure was not deemed “necessary” or not specifically covered by your policy
- Reasons applicable to the cost of treatment
- Unresolved Issues with network healthcare providers
Are the reasons valid?
In some cases, the reasons given by the insurance company may not be valid, which is why you need to review your actual policy carefully. Remember, the insurance company owes you a duty to act in good faith, indemnify you and settle any claims according to the policy.
If your claim is denied, you can file an appeal internally with your insurer for a review. Sometimes, providing more documentation or correcting the paperwork resolves the problem. However, your claim may still end up being denied in some instances.
What next?
If you think your insurer is acting in bad faith, it is essential to protect your legal rights. You deserve the insurance benefits if you have been holding up your end of the deal and observing the policy rules. Being familiar with the law surrounding your situation is the best place to start to ensure you receive the benefits to which you’re entitled.
