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
453
views

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.

Popular Right Now

Everything You Need To Know About BANG Energy Drinks

Say goodbye to your favorite pre-workout drink.
313429
views

BANG energy drinks from VPX Sports are the hottest new products for athletes everywhere. On every can, you'll find their catchphrase "Potent Brain & Body Fuel" and it gives you just that. Clean energy, laser-sharp focus, and no sugar induced crashes are just a few of the reasons these bad boys are flying off the shelves faster than retailers can keep them stocked. Haven't heard of them? Sound too good to be true? Let me answer your questions.

What is it? It's an energy drink that's kind of like your typical Red Bull or Monster. It's a perfect substitution for pre-workout supplements or coffee.

Who's it meant for? Anyone! A better question to ask is, "Who isn't this drink meant for?" On the can, you'll find a recommendation for no one under the age of 18 to consume the drink. You also may want to steer clear of it if you're sensitive to stimulants like caffeine.

What's in it? BANG energy drinks contain zero calories, zero carbohydrates, and zero sugar. But what you can find are BCAA's, CoQ10, creatine, and copious amounts of caffeine. These are things athletes often take as supplements.

What are BCAA's? BCAA's are Branched Chain Amino Acids. They are known to stimulate protein synthesis, increase muscle function, decrease your soreness after a workout, and even aid in repairing damaged muscles.

What's CoQ10? Coenzyme Q10 is found in the mitochondria of your cells and sparks energy production. It helps produce energy your body needs for cell growth and maintenance. People often take this as a dietary supplement when they feel tired or lethargic.

What's super creatine? Creatine does a great job in enhancing athletic performance by aiding growth of lean body mass (AKA muscle). When you take creatine orally, the amount in your muscles increase and helps regenerate ATP more efficiently. According to the nutrition label, this so-called "super" creatine is bonded to Leucine to make Creatyl-L-Leucine. On SupplementReviews.com, a VPX Sports representative allegedly said the following about the Super Creatine in the drink:

"The creatine in there is actually something very special...it is the world's only water stable creatine. It is Creatine-Leucine peptide. Think of this...if you mix creatine in water, it sinks and if you mix leucine in water, it floats....if you combine the two into a peptide, it creates a water soluble and water-stable form of creatine. It also has a fatty acid chain that makes it easier to cross the blood brain barrier. The focus of the super creatine is not for muscle function, but for cognition...by combining this form of creatine with caffeine, it works synergistically for mental focus."

How much caffeine is in one can? In one can of BANG, you'll be blessed with 300mg of caffeine. This is the equivalent to over three cups of coffee.

Is that even safe? Yeah, it is. In order for the caffeine in the energy drink to be lethal at any capacity, I would have to drink 30.7 cans.

So, what are the downsides? There are two things that come to mind. One is that consumers have no idea how much BCAA's, CoQ10, or creatine is actually in the drink. It could very likely be trace amounts too small to do anything beneficial. Two, BANG energy drinks do not go through the FDA approval process.

Is it really that good? Well, out of 113 reviews of the product on Bodybuilding.com, there's an average 9.6 overall rating. Most reviews comment on the quality of the energy, the cognitive focus, and the non-existent crash once the drink wears off.

What kind of flavors can I get? There are currently eight BANG energy drink flavors on the market: Black Cherry Vanilla, Cotton Candy, Sour Heads, Star Blast, Blue Razz, Champagne Cola, Power Punch, and Lemon Drop.

Where can I buy BANG energy drinks? You can find BANG energy drinks at Amazon, your local GNC or Vitamin Shoppe retailers, Bodybuilding.com, VPX Sports' website, some gas stations, and privately owned retailers.

How expensive are they? This depends on where you make your purchase. The cheapest place to purchase your BANG energy drinks is at Bodybuilding.com for about $2.00 per can. You can find similar prices on Amazon and at your local retailers. The energy drinks are most expensive through the VPX website where you'll pay about $2.75 per can.

How does BANG compare to other energy drinks? I'll give you some data on nutrition facts and you can make your decisions based on that:

16 oz. BANG: 300mg caffeine, 0g carbohydrates, 0g sugar.

16 oz. Monster Energy (regular): 160mg caffeine, 54g carbohydrates, 54g sugar

16 oz. Red Bull (regular): 160mg caffeine, 56g carbohydrates, 56g sugar

16 oz. Rockstar (regular): 144g caffeine, 54g carbohydrates, 54g sugar

Cover Image Credit: Youtube

Related Content

Connect with a generation
of new voices.

We are students, thinkers, influencers, and communities sharing our ideas with the world. Join our platform to create and discover content that actually matters to you.

Learn more Start Creating
Facebook Comments