When your medical billing claim is rejected it is not only disappointing but also stressful as in such a case the expenses will be paid from your pocket. Despite best efforts, many times the claims are rejected out rightly. The most common reasons for rejection of medical claims are:
1. Preauthorization and Referrals
Certain insurance plans require a preauthorization or a physician’s referral to avail services like CT scans and MRIs thus in case any of the two are absent, the claim may get rejected. Always check the terms and conditions of your Health Insurance policy or call the customer care to get clarity.
2. Failing to File the Claim Within Specified Time Period
Usually the claims for Operation/Treatment have to be filed within 30 days and the post-operative medical bills have to be filed within a period of 60 to 90 days. In case you fail to file the claim within the period specified, the medical bill claims will be rejected.
3. Failing to Provide Full Documentation
There are certain diseases for which the operation is required much later than its onset. For example, in case of Cataract, the doctors usually wait for the right time to perform the operation and it may get postponed for a year or two since the first time it was detected by your eye specialist. It is always recommended to keep your medical prescriptions and documents at one place so that it can be furnished if the Insurance company asks for it at the time of claim settlement.
4. Failing to Renew Your Health Insurance
Last but not the least, if you’ve forgotten to renew your insurance plan in time, then your claims will be rejected no matter for how many years you’ve had the insurance coverage and whether you’ve made a claim earlier or not. It is always advisable to renew your health insurance 10-15 days in advance as the policy will come in effect only after the current year is completed.
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