Most Common Source of Insurance Denial


Insurance is one of the biggest assets of one’s life and people prefer it in order to reduce the risk factor of life. Life is all about uncertainties, and we always think about our dependents and plan something good for their future even in our absence. There are some cases seen where the claim of compensation is denied because of some issues. So in order to increase the knowledge of the people we are mentioning most common sources of insurance denial.

Suspicious Coding Method: In order to claim the insurance, one should submit the proper document of the investor and code towards the health issues should be mentioned in a transparent way. If any discrepancy is found in the code then claim is suspended.

SEE ALSO:: How to Fight Against an Insurance Claim Denial?

Some Examples of Code Are As:

  • As per the norms of ICD – 9, the code for essential hypertension is 401.0.
  • As per the norms of ICD – 10 the code for essential hypertension is I10.

Reasons for Insurance Claim Denial

1. More Than One Claim for Same Insurance:

More Than One Claim for Same Insurance - Most Common Source of Insurance Denial

In most of the cases the claim denial occurs due to the more than one claimant. Due to the mistakes of internal staff member one file is submitted more than one time and hence confusion starts. This is the reason staff members of insurance companies are always recommended to follow up on the submitted file rather creating new request for the same.

2. Missing or Lack of Information:

Missing or Lack of Information - Most Common Source of Insurance Denial

The insurance denial takes place due to mission of important information. As you all are aware that processing could not be proceeded without the supporting document and hence once should ensure the completion of the document in all means. Sometimes important information such as Name, Medical treatment or date of accidents is missing and hence insurance claim is denied.

3. Overdue Claim:

Overdue Claim - Most Common Source of Insurance Denial

If the claimant becomes late in filing the claim towards the insurance then denial takes place. There is a time bound limit to claim the insurance and if anyone crosses that window then it may get denied. Initially the claim – submittal period was between 15 to 27 months but now it is limited to 12 months only. The decision is taken in order to maintain the confidentiality and privacy of the user. In case of Medicare claim the start date is counted from the date the service is provided to the patient. Also, if you have filed the claim before the last and it may get delayed in reaching somehow, even then it will get denied.

Incorrect Information about the Patient:

Incorrect Information About the Patient - Most Common Source of Insurance Denial

If the claim is raised with wrong name of the patient then you will have to face the problem of insurance denial. Hence one should always ensure the correct information in regards to the patient.