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
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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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A Love Letter To The Girl Who Cares Too Much About Everyone But Herself

You, the girl with a heart full of love and no place big enough to store it all.

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Our generation is so caught up in this notion that it's "cool" not to care about anything or anyone. I know you've tried to do just that.

I'm sure there was a brief moment where you genuinely believed you were capable of not caring, especially since you convinced everyone around you that you didn't. But that just isn't true, is it? Don't be ashamed of this, don't let anyone ridicule you for having emotions.

After everything life has put you through, you have still remained soft.

This is what makes you, you. This is what makes you beautiful. You care so deeply and love so boldly and it is incredible, never let the world take this from you.

Have Your Voice Heard: Become an Odyssey Creator

You are the girl who will give and give and give until you have absolutely nothing left. Some may see this as a weakness, an inconvenience, the perfect excuse to walk all over you. I know you try to make sense of it all, why someone you cared so much about would treat you the way they did.

You'll make excuses for them, rationalize it and turn it all around on yourself.

You'll tell yourself that maybe just maybe they will change even though you know deep down they won't. You gave them everything you had and it still feels as if they took it all and ran. When this happens, remind yourself that you are not a reflection of those who cannot love you. The way that people treat you does not define who you are. Tell yourself this every day, over and over until it sticks. Remind yourself that you are gold, darling, and sometimes they will prefer silver and that is OK.

I know you feel guilty when you have to say no to something, I know you feel like you are letting everyone you love down when you do. Listen to me, it is not your responsibility to tend to everyone else's feelings all the time. By all means, treat their feelings with care, but remember it is not the end of the world when you cannot help them right away.

Remember that it is OK to say no.

You don't have to take care of everyone else all the time. Sometimes it's OK to say no to lunch with your friends and just stay home in bed to watch Netflix when you need a minute for yourself. I know sometimes this is much easier said than done because you are worried about letting other people down, but please give it a try.

With all of this, please remember that you matter. Do not be afraid to take a step back and focus on yourself. You owe yourself the same kind of love and patience and kindness and everything that you have given everyone else. It is OK to think about and put yourself first. Do not feel guilty for taking care of yourself. You are so incredibly loved even when it doesn't feel like it, please always remember that. You cannot fill others up when your own cup is empty. Take care of yourself.

Cover Image Credit: Charcoal Alley

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College Is NOT The Place To Be A Perfectionist, In Fact, It's Nearly Impossible

Accept it and move on.

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Life is hard for a perfectionist, and it only gets harder if it keeps itself up.

There is such little room for a perfectionist to mess up, and college is full of mess ups. That's why no one should expect themselves to keep entertaining the thought of perfection past high school. You can always chase it and never reach it, or you can work as hard as you can and get exactly where you want to be.

I was a perfectionist my entire life.

People always criticized me for it and said it would come back to bite me later. Of course, I never believed them because it worked out in my favor. I was getting where I needed to be and all the self-discipline is what I assumed got me there. Fast-forwarding to the present, they were right. It did come back to bite me. Actually, it is biting me.

I was setting myself up for failure all that time and I ignored it. I was only after perfection up until college because it wasn't that hard to obtain. I didn't have to study and I had time for my friends. But then things got harder out of nowhere and I was not prepared at all to shift the standards I had for myself.

As a perfectionist, I constantly compared myself to other people and made sure I was doing better than the next guy, or at least just as well. That didn't work for long. I stopped competing with others because I learned that no one is worth beating if they aren't even chasing the same goal. And that helped me learn to quit competing against myself, too, because we're on the same team.

Freshman year of college, I almost pulled it off. The perfectionist in me nearly won. Then I started reasoning with myself and I figured out I had limits to what I could handle and I stopped pushing myself past them.

There are sacrifices that have to be made in reaching success.

College is like the triangle you can only pick two things from. On it might be grades, free time, and work, and you have to give up free time to have a job and good grades. A perfectionist will try so hard to get all three, and they may be able to at first. But it catches up with you.

Then there are other times where you're lucky to get one piece of the triangle. It's a game of going back and forth and testing patience in the pursuit of greatness.

I may end up with an "A" in a class because I only studied for that one exam, and in return, I might fail a quiz that same week. It would have bothered me to not evenly distribute my time and to not do perfectly on all of it, but it's actually OK. And the job that may take up way too much of my time will look really good on my resume and the time I didn't have to enjoy myself won't matter later.

And as bad as they seem at one particular moment, sacrifices are worth it in the end. Some things just carry more weight than others and the further I've gotten, the more I've figured it out. And I just try to remember that when I reach the point where I've gotten exactly where I wanted to be, no one is going to ever know what I had to give up to get there. And there's even a chance I won't remember either.

As long as I'm actually trying as hard as I can and I learn from every hiccup and mistake, things will work out the way they should.

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