If you are a Texas resident who has ever had the unfortunate experience of having your health insurance claim denied, you may know full well just how anxiety-inducing this can be. An unexpected claim denial can leave you facing massive medical bills, leaving you in the hole without knowing how you are going to pull yourself out. Attorney Jon Michael Smith understands how upsetting it can be to have your insurance company deny your claim, and he has helped many clients facing similar circumstances pursue appropriate recourse.
Per Nerdwallet, insurance companies issue many health insurance claim denials for similar reasons, so recognizing factors that commonly lead to claim denials can help you avoid one in the first place. You may hear, for example, that you received a claim denial because you visited an out-of-network medical provider. Typically, insurance companies work with certain providers who have an existing understanding and agreement about billing practices, so check with any medical provider before signing on to make sure it falls within “your network.”
Another common reason health care claims are denied is because patients fail to obtain preauthorization for a particular procedure. This is something your physician can request for you, so make sure he or she does so before you receive treatment.
Another very common patients may have a claim denied is because they have procedures their policies do not cover. For example, you may receive a claim denial after having dental surgery that was cosmetic in nature if your policy does not cover cosmetic expenses. Find more about denied insurance claims on our web page.