Health insurance claim denials are becoming more and more common. Typical reasons for claim denials include: incomplete or inaccurate insurance information; lack of pre-certification or prior authorization; diagnosis and procedure coding errors and omissions; and, insufficient medical necessity.
When do you give up on a denied health insurance claim? It might not make sense to most of us, but insurance companies attempt to spread risk and keep as much money in their company for as long as possible as they “adjudicate a claim.” Auditing software, often called “claim review programs,” sifts through claims. These programs work by finding technical errors in billing codes that all doctors, hospitals and clinics, among others, submit for payment. The programs use data-mining technology and can even be tuned to capture a predetermined percentage of financial return.
If you have had a health insurance claim denied, contact your insurance provider to try and have the claim recovered. We have found that over 50% of claims that are denied can be eased or resolved with a little due diligence on your part. For information on how we may be able to help, call 800-344-5677.