5 Reasons Your Health Insurance Plan Will Deny Your Claim

5 Reasons Your Health Insurance Plan Will Deny Your Claim

If you've changed health insurance providers since the last time you visited your doctor, the office may have a different insurance provider on file

Health insurance is supposed to be there when we need it. We pay into it each month so that we can afford to get the health care we need when we are sick or injured. But what happens if your insurance company denies your claim? There are many valid reasons why a claim may be denied. Here are five of them:

1. You Waited Too Long to File the Claim

Every insurance company has its own "window of opportunity" to file a claim. Most insurers give policyholders 90 days from the date of service to file a claim, but some only allow 30 days to file. Medicare allows a year.

If you waited too long from the time of service to file a claim, it will be rejected.

2. The Insurance Claim Was Lost and Expired

Insurance companies sometimes lose, or misplace, claims. If a lost claim doesn't make it into the system before the deadline, it will be rejected – even if it's their fault.

The insurance company will likely tell you that there's nothing they can do, as the deadline has expired.

3. A Pre-Authorization Was Required

Many insurance companies require patients to obtain pre-authorization of services before receiving treatment. Pre-authorization is usually required for non-routine services, like surgery, hospitalization or behavioral care.

Your doctor should request pre-authorizations on your behalf, but sometimes, claims are denied afterwards. If your claim is denied but your doctor has already ordered tests, ask your doctor to talk to your insurance company on your behalf.

4. You Used a Provider that Wasn't in Your Network

If your insurer is an exclusive provider organization or a health maintenance organization, your claim may be denied if you used an out-of-network provider.

Using a provider outside of your network means that you've chosen a health care provider who hasn’t agreed to your insurer's terms of payment. If your claim is denied for this reason, you may be on the hook for the bill, or you may be required to pay a larger share of the bill.

5. The Bill Was Sent to the Wrong Insurer

The reason for your claim denial may be simple: the bill went to the wrong insurance company. If you've changed health insurance providers since the last time you visited your doctor, the office may have a different insurance provider on file.

Having two insurance companies on file can also cause confusion.

Check to make sure that your provider has the correct insurance company information.

What happens if your insurance company doesn't give you a reason for your claim denial? You can fight back, and the insurer may be liable for a bad faith claim.

According to Law Office of Matthew L. Sharp, "Insurance bad faith laws make it unlawful for an insurance company to fail to treat a customer in accordance with the duty of good faith and fair dealing. In general, insurance companies must fulfill the following obligations to their customers: Promptly and fully pay a claim covered by the insurance policy, conduct a fair and complete investigation before a claim is denied, and provide the customer with the factual and legal reason for denying any claim."

If your insurance company hasn't provided you with a valid reason for your claim denial, you may have legal recourse and should consider consulting with an attorney.

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Infectious Compassion

Give a Stranger Some Free Hope!

I am definitely no newbie to this; doctors, hospitals, medications, therapies, insurance, paperwork, and the waiting. The dreaded waiting. Often the cure is worse than the disease, but the wait amplifies the symptoms of said disease. 

Like I said, I am no newbie, but I also am not an expertise. If I were an expertise I wouldn’t need the doctors, and all of that goes with being ill. But one might come to believe that after 26 years, one would at least develop a thicker skin. I try to imagine how a great spiritual leader might advise me when I fall through a crack in our system. I ask myself what lesson can be learned, for my future, and the avoidance of other cracks. I even try to learn from others who have fallen, and pass forward any pertinent knowledge I have accumulated. 

Knowledge is power, unless you’re sick. Money is power, unless you’re sick. Knowledge and money give the sick more options, but sick is still sick. Dying is still dying. Death is still death. 

With all of my knowledge, all of my wants, all of my needs, and all of my wishes, only one thing has been a constant in dealing, coping, and even healing. It is actually very basic, but often the most elusive. A placebo of sorts, amazingly it is still in short supply, but high demand. 

One cannot bottle it, market it, sell it, or cure the sick with it. But it is the most contagious agent I have ever been exposed to. A touch, a smile, a hopeful gesture or word, and I am instantly infected. Once I am infected my only desire is to infect all around me. 

So here is the big secret, the elusive placebo, the virus I covet more than any cure some specialist, drug rep, hospital, or guru peddles: Compassion. 

Devastating news is just that much easier to take in when compassion is bound to it. I accepted a long time back that I would either die from my diagnoses, or with them. No cure in sight, just a hindered life. Even though I don’t like my illnesses, I’m okay with this, I am okay with me, who I am, who I turned out to be. 

We humans don’t have to like disease, or even accept it, in us or others. But could we at least show a little compassion? For a few seconds? A fake smile? Something? 

The next time you are having a wonderful day, think back to a day that was the exact opposite. Now, the stranger next to you? That just might describe their day. Would you have liked a miniscule amount of compassion on the day you remember? Might a slight exposure of infectious happiness have helped you? 

Commit a random act of kindness and infect a stranger with some compassion! Pass it on! 

  

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With The New Year Already Gone, How Can We Improve Ourselves?

Its Never Too Late To Make A Commitment To Making Yourself Better

As January begins, people always talk about how their news years resolution never work out. Most of the time, they are right. But finding a good balanced resolution can be key. The resolution shouldn't be impossible but it also should be able to challenge you and prove to yourself that anything is possible. Here are 3 resolutions that I think all of us should begin a February as a way to make ourselves the best people.

1. Being kind to those around us

This one can be quite tough. Sometimes we just have those moments where nothing is seeming to go right and there is only a few people to blame. Overcome those emotions of anger or hatred and instead focus on improving yourself. If you got yourself into the situation, you are more that likely to get yourself out of it. This will not only improve your image to that person who you know, but also to others who may be trying to get to know you better.

2. Don't be Lazy

Not gonna lie, this is one of the hardest resolutions for people to follow. A long hard day at work or at school can often be the breaking point for people and might force them to stop doing what is necessary. For students, it might be putting in the extra work or in my case, going downstairs to get something. Being lazy is a problem for all of us and I think the best way to fix it is to start thinking of ways to keep this resolution.

3. Keep a Positive attitude

When times are good, a positive attitude is easy to keep. But as obstacles cloud our path, our negativity grows more and eventually can't be stopped. Being one of the biggest pessimist I know, keeping a happy attitude can change more than just in our own personal lives. A smile or a laugh is all it takes to brighten up someones day. Remember if you are going through a hard time, someone else also is. Showing them a sign of faith and belief in them can give them the final push to overcome their conflict.

These three resolutions are meant to help us make 2018 a year full of laughs, memories, and improve on 2017. Each of these commitments to improving ourselves will also affect others around us. Good luck keeping these resolutions.

Cover Image Credit: Flickr

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