Claim Denials | What Is The Most Common Reasons Insurance Companies Deny Claims?

Updated: Jul 8, 2021



Imagine this:


You just got off work and it is a beautiful Friday evening. You and your family have a camping trip planned for the weekend out in the beautiful springs (or mountains if you live near some mountains). You're packing and constantly have to make trips up and down the stairs with the luggage for your kids, when all of a sudden, you stumble over some building blocks that your 6-year-old left in the middle of the stairs...


...next thing you know, you're in the hospital for a broken ankle.



What a weekend. Sometimes we don't think twice as to when or how our insurance companies pay medical bills on the backend. Even for something, that we may think is, as simple as going to a counseling session for childhood trauma or PTSD or for seeking help in general.



But the question remains, why DO insurance companies deny claims? What's the MOST common reason?



Let me introduce you to my friend... the coverage disavowal.




A health care coverage disavowal happens when your health care coverage organization will not compensate for something. On the off chance that this occurs after you've had the clinical help and a case has been presented, it's known as a case refusal.


Safety net providers additionally here and their state early that they won't pay for specific help, during the pre-approval measure; this is known as a pre-approval—or earlier approval—disavowal. In the two cases, you can bid and might have the option to get your guarantor to turn around their choice and consent to pay for at any rate part of the assistance you need.



So how can you fall into denial? Here are a few common denials are listed below:

  • Missing Information

  • Timely filling limit Expired

  • Duplicate Claims

  • Member not identified as insured

  • Member is not eligible for service

  • Non-covered charges

  • Service not covered by payer


Hope this helps!




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