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July 2022
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Knowing why your healthcare insurance claim was denied is the main factor. It lets you see whether you can appeal your claim. If your medical appeal succeeds, the company must pay for the claim even though it was denied at first. Here are five common reasons healthcare insurance claims are denied: 1. Incomplete or missing information in the submitted medical claim documents is the most common reason you claim is denied or medical billing errors by your hospital or service providers. 2. Your healthcare insurance plan might not cover what you are claiming, or the procedure might not be deemed medically necessary. 3. You may have maxed out the insurance coverage limits in your plan. For some treatments such as physical therapy, there is a limit in your plan for the number of sessions you can avail. 4. The drug or therapy is off-formulary and not part of your healthcare plan. At times a particular brand of medicine or type of therapy is not covered in your plan. 5. You may have used out-of-network services or used your health insurance out of state when your health plan requires "in-network" providers.
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