Health insurance can be confusing, especially if you don’t really understand what it covers and what it doesn’t cover. When your doctor prescribes you medication, your first instinct may be to head straight to the pharmacy to get what you need as soon as possible. However, your health insurance may not cover the full cost of your medication, leaving you with more bills to pay out of pocket.
What are the top reasons why health insurance companies refuse claims?
Insurance companies are big business that makes a lot of money, even though they’re supposed to be an intermediary between people and doctors and hospitals. But their main focus isn’t necessarily on getting people good care at reasonable prices; it’s on maximizing profit for shareholders. This means denying claims for seemingly arbitrary reasons. Insurance providers generally fall into one of two HMOs may refuse your claim because you’ve exceeded your deductible, which was often set artificially high by way of a monthly payment plan that you chose in advance.
How can I find out if my claim was refused before paying it myself?
If you’re worried that a claim has been refused, always contact your insurer first. The insurer should be able to tell you whether they have rejected it or not. If they won’t tell you, ring Medicare on 1800 622 222, and you can also ring your state government’s Health Insurance Ombudsman who can assist with complaints about private health insurers. However, an insurer doesn’t have to tell you why it has rejected a claim unless it relates to clinical services such as surgery or consultations with a GP.
What should I do if I think my claim has been wrongly refused?
If you have a dispute with your insurer, there are things you can do. It’s always best to make sure you understand why your claim has been refused first – then consider taking further action. If it’s clear that an insurer has wrongly refused your claim, there are steps you can take as a claimant.
Tips on Dealing with a Claim Refusal from your Health Insurance Company
It can be a terrible feeling when you’re denied coverage by your insurer, especially when it means that you won’t be able to afford an essential procedure or medication. While nothing can make up for having a claim denied, it may help to try some of these tips
Examples of Health Insurance Companies Refusing Claims
Companies will always try to dodge paying their full fair share of claims. This can be done by lying or altering facts and information on a patient’s claim or by simply denying a claim outright. Here are some examples
It can be frustrating when your claim is denied. It may mean you have to fork out for costs that were previously covered,. And it could affect your relationship with your provider. On top of that, many health insurance companies have a habit of lying or misleading their clients. Which can make dealing with them even more frustrating. Some firms, for example, may try to perplex you by declaring. That their counterclaim was obtained in a specified time frame or by providing irrelevant justifications. Unfortunately, one way they get away with doing this so often is because patients either don’t realize or don’t think they can do anything about it.