Reasons for Medical Claim Denials

Reasons for Medical Claim Denials

What Can Be Done?

Health insurance covers hospital expenses including pre- and post-hospitalization as well as in-patient treatments.

Sometimes, health insurance claims will be rejected for certain reasons. Medical review companies can assist in reviewing the medical records of the claimants.

Key reasons for claim denials are – Waiting period involved Pre-existing diseases Inaccurate data Health plan period Exclusions Medically not necessary procedures Absence of documentation Out-of-network provider

Solutions Claimant can go for an internal appeal Appeal can be taken to an independent third party for review

To avoid claim denials Know exactly what is covered Stay compliant with the rules Understand the limits on the benefits Check whether the claimant’s physician is in their health plan’s network

LEGAL SUPPORT IS VITAL IF INSURERS HAVE DENIED THE CLAIM WITHOUT CONDUCTING A PROPER INVESTIGATION.

Social Media Headquarters:

Contact Us

8596 E. 101st Street, Suite H Tulsa, OK 74133 Main: (800) 670 2809 Fax: (877) 835-5442 E-mail: info@managedoutsource.com sales@managedoutsource.com

Thank You