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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How My Diabetes Taught Me That Worry Is Pointless

My life is in the hands of the Creator.
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I am slowly running out of test strips.

Funny story about my prescription: It only ever refills once a month. So I'm attempting to make them stretch. Here's the problem with that one, though: I'm a paranoid diabetic.

My insulin dosage changed about a month ago. I was taking my long-lasting stuff right before I went to bed, so I was used to waking up in the middle of the night in the sixties or fifties. So, every time I woke up, I'd take my blood sugar, just to make sure. Since then, I've gone back to taking the long-lasting insulin in the morning, and my numbers have, overall, gotten better. I'm usually fairly solidly in the middle zone I need to be.

But I still check my blood sugar constantly.

See, the other day, I took a two-hour nap after one of my classes. I was at 204 when I went down (so not good, but also not really likely I'm going to slip low while I'm asleep). I woke up at 48. For those of you who aren't familiar with proper numbers for diabetes, that's really flipping low. In fact, I haven't been that low yet in the two years I've been diabetic.

Ever since I've been paranoid. I take my blood sugar every time I feel the slightest twinge of a weird feeling. It can be the exact opposite of what I remember being low feeling like. I'll still take it. While this isn't necessarily a bad idea, it's also kind of causing me to lose sleep at night and go through canisters of test strips at record speed when it's not necessary.

I felt like I was living on borrowed time.

After a few days of walking around feeling like maybe I wasn't supposed to wake up from that low and jumping at the slightest wind, convinced the nearest university vehicle was going to bowl me over in the next five seconds, I finally sat still and prayed.

God, I'm scared. I feel like I dodged a bullet. What if I wasn't supposed to dodge it? What am I supposed to do here?

And I felt this strange assurance: Rachel, I'm God. If you were meant to be home with me, you would be.

Some might call that threatening, but I call it relaxing. It means I can go day to day with the knowledge that the God of the universe holds my life in His hands, and as long as He still has something for me to accomplish on this earth, I'll be here. I can screw up daily, and He will still take me back and love me. He'll give me a second chance.

So, no, I haven't quite gotten to the point where I don't use my test strips generously. But I know there's a reason why I'm still here. And therefore, why should I worry? What should I fear?

Cover Image Credit: Pixabay

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When I Look At My Life Now, I Forget I Used To Be Suicidal

I used to want to kill myself over what people said. Now I am much stronger.
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I was reading someone’s post celebrating how they haven’t self-harmed in years. I realized I haven’t self-harmed in years but I can’t remember the last time I celebrated it. It’s like I have almost completely forgotten that I used to be suicidal. I know it sounds awful, but I don’t know if I have blocked it out myself or if other people have done that for me.

Life used to be so hard and almost impossible. I remember crying myself to sleep every single night and wishing I was dead or that I was never born. I remember carving “worthless,” “crazy,” and “dramatic” into my legs because that was how everyone around me thought of me.

I remember being forced to go to therapy knowing what she was telling me would be pointless when my session was up and I had to go home. I remember trying to kill myself three times.

I still have scars, both visible and internal. I will never be able to love or trust anyone the way most people do. I will never be able to feel at home in my own house. I will never be able to get my childhood back. These open wounds will forever change my relationship with my family even if it’s just in my head.

But I don’t totally regret it. I reached the lowest point of my life as a child and now it can only get better. I am now so much stronger. I learned how to stand up for myself. I learned how to be who I am and not worry about what my family would think.

I was willing to kill myself over what people said to me and about me. I was trapped in my own body, in my own house, and in my own town and now I am free. I brush off what anyone thinks of me because it is my life, not theirs.

I left everything that was weighing me down and moved to a city where I didn't know anyone. This was everything I needed to forget that I was once suicidal. Now I am able to be myself and do what I love. I am surrounded by the greatest people who believe in me and push me to be a better version of my self every single day.

Life is so great and it seems like another person was suicidal, not me.

But it was me. I will have to work every day to overcome my depression and anxiety. But some days are better than others and so I am able to grow stronger and fight back harder.

Nothing that happens to me now could be as bad as what I faced growing up. So I laugh. I look my enemies in the face and laugh. Because they have no power.

National Suicide Prevention LifelineCall 1-800-273-8255

Cover Image Credit: Akash Desai

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