Caring for yourself and your family or spouse with health care usually requires health insurance coverage. Whether you’re applying for coverage with a new insurance company, or you suddenly lost coverage, being denied coverage can be scary and frustrating. At Simerly Ayers, our team is here to help our clients better understand how and why they may be denied coverage by insurance companies, and see if there are any possible solutions.
Common Reasons Insurance Companies Would Deny Coverage
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Pre-Existing Conditions
One of the most common reasons why clients may be denied coverage is due to pre-existing conditions. What that means is that your insurance company decides that your health condition, disease, or chronic illness would likely cost them too much money, time, or effort, so they deny coverage to avoid the loss. If this is the case for you, you do still have options, so contact our team to get the guidance and help with coverage that you deserve!
Age Requirements
Another important thing to remember is that not all plans, programs, or coverage options are created equally. If you’re applying age-restricted coverage options, like Medicare, you may denied coverage if you don’t meet the criteria for age. Learn more about Open Enrollment for Medicare Over 65 or Medicare Under 65 from our website.
Perceived Medical Necessity
If you haven’t lost coverage completely, but a procedure or other claim has been denied coverage by your insurance company, one of the most common reasons for denial is the insurance company’s definition of medical necessity. If your insurance company deems a particular claim as an unnecessary one, you will likely have to pay for it out of pocket.
Paperwork or Information Confusion
On the other hand, if you’re dealing with a claim denial that does fall within the boundaries of necessity and should be covered by your insurance company, you may be the victim of a paperwork mix-up. Coverage denials can occur when the paperwork is incorrectly filled out or incorrectly submitted.
Learn more about insurance coverages, denials, and more at Simerly Ayers. Contact our team to get the guidance you need to navigate through the confusing world of insurance and find out if there is a solution for you.