3 Major Reasons Why Medical Claims Are Denied

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Understanding the reasons why insurance companies sometimes reject claims filed by healthcare providers can help you prevent or limit denials from insurance companies when submitting your claims. In this article, we will be looking at some of the common reasons why medical claims are usually rejected by insurance companies.

Wrong patient identifier information:

Misspelled names, incorrect date, and invalid subscriber number are some of the common causes of incorrect patient identifier information. When a patient identifier information is incorrect or doesn’t match with the details of a patient’s health insurance plan, such claim will be rejected by the insurance company due to the differences.

Non-covered services:

Due to one reason or the other, a patient’s health insurance plan may not cover certain medical services, patients are expected to make full payments for such service. And when such medical services are rendered, insurance companies will reject claims for such services since the patient’s insurance plan doesn’t cover such services.

This is why is better for healthcare providers to contact a patient’s insurer before rendering services. By doing so, the medical biller will know if a patient’s insurance plan covers a medical service or not.

Further documentation:

Sometimes, a patient’s insurer may request for medical record of the patient before claims for services rendered to the patient will be approved. This is another reason why medical claims are sometimes rejected.

All these are some of the reasons why medical claims are usually rejected by insurance companies. And with these, a healthcare provider can prevent or limit the number of denials.

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