Health insurance claims not being covered are perhaps the worst thing next to actually being ill and or seriously injured. This is especially true when you know the medical bill will be a big one. On the bright side, you do have the right to know why the specific treatment won’t be covered which you can receive in the form of an “explanation of benefits”. This will provide the necessary information meant to explain the payments and policies. However, before getting caught up in this process, it’s good to be aware of some of the more common ways in which your medical expenses are not covered. This can save you time in fixing the issue:
1. Uncovered charges – Often times, its as simple as your health insurance policy not covering a particular type of charge. Either you picked a policy that is picky, or you’re with the wrong provider. Double check the terms of your policy so that this doesn’t come as a surprise. A common treatment that isn’t covered is infertility treatment. If this lack of coverage proves expensive enough, you may want to consider switching your policy and or provider.
2. Dental coverage – Dental treatments are perhaps the most commonly excluded areas of coverage. Most people are forced to either pay for dental insurance on an entirely separate basis or pay heavy premiums. However, many insurance providers have created family packages that do provide the dental coverage for a small premium. Either way, it’s always best to be aware of whether or not your provider does cover dental, as without any form of insurance, the procedures can be devastatingly expensive.
3. Ct scans and MRI’s – Treatments like CT scans and MRI’s will often require a pre-authorization agreement with the given insurance provider. While some practitioners will simply turn you away without the pre-authorization, other times the claim may be denied after the procedure has taken place. This can leave you in a bind without a way to pay. However, in the case that it is denied after the procedure takes place, you stand a better chance of resolving the coverage issue with your doctor’s help.
4. Providers from outside your network – If you receive health insurance from a more exclusive organization, you may be denied a claim if you go outside the plan’s network. Going outside the network simply means that the provider has not yet agreed to the particular terms of your insurance company. It is likely that if you subscribe to a so called “elective” or “nonemergency” care system that your insurance claims will be denied after any given treatment that can be described as planned or not emergency like in nature. Even something as simple as going to the hospital for head lice could leave you vulnerable to heavy and unexpected payments.
5. Check your documents – Many times people are denied for simple technical errors in the registration process. They mistakenly claim to be born in the wrong year, or provide insufficient information necessary to be covered for risky procedures. Double check any and all documents you use in correspondence with your insurance companies, and make sure you fix these as soon as possible. Believe it or not, claims have been denied over trivialities like these.