According to data from the health insurance industry, approximately one in 14 of all health insurance claims are denied by the insurance companies. Worse yet, only about half of all patients who appeal their claims end up winning. Much of the time, this subsequent denial is due to a lack of experience or understanding of the health insurance appeals process. If you or someone you love is facing a denied health insurance claim, the following information can help.
Understanding the Most Commonly Denied Claims
Before going up against a denied claim, it is important to understand why it was not covered by your insurance company. This can help you plan a strategy, and may even provide you with the knowledge you need to fight back. For example, you might receive a denial for an unauthorized service or procedure if your doctor failed to receive preauthorization. Alternatively, the denial could be due to an error in coding (the method doctors use to bill for procedures), or because a critical piece of data was entered incorrectly. This happens in about 10 percent of all claims. Other reasons that a claim might be denied could be related to a billing for the same procedure on the same day, or because you have allegedly exceeded the maximum number of times a procedure is allowed. Denials because a plan does not cover a procedure are also common.
Why Patients Should Not Try to Fight Denied Claims Alone
Although patients can and sometimes do fight back against denied claims on their own, it is highly discouraged. This is not just because you could be denied, yet again, possibly leaving you responsible for a bill you cannot and should not pay, but also because the process is difficult and complex. It is an added stressor in your life - one that you may not need. This can be especially true for those who suffer from severe and/or chronic injuries, illness, or disabilities since they are more prone to insurance claim denials and far more likely to struggle with the appeals process due to a lack of time and/or energy.
Our Rolling Meadows Insurance Dispute Lawyers Can Help
Fighting a claim does not have to be an impossible feat. Instead, let Drost, Gilbert, Andrew & Apicella, LLC help you with the process. We handle all the legal details, protect your interests, and fight for a favorable outcome. Learn more about how we can assist you. Call 847-934-6000 and schedule your consultation with our Rolling Meadows insurance dispute lawyers today.
About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.