Health Insurance

Health insurance claim denials

Generally speaking, your health or medical insurance claim is based on medical expenses you incur for covered treatment. Once you submit your health insurance claim, the insurer will subject it to a critical review, many times looking for any reason it can hang its hat on to deny benefits. For example:

  • The health insurance company says the condition you had treated is a pre-existing condition.
  • The health insurance company claims your treatment wasn’t “medically necessary” or was “experimental or investigational.”
  • The health insurance company says you failed to obtain the proper pre-authorization or referral for the treatment.
  • The health insurance company says you received the treatment from an out-of-network medical provider.
  • Your doctor’s office entered an incorrect diagnosis code or made some other clerical error the health insurance company says justifies denying benefits.
  • The health insurance company says some other insurer is responsible for paying some or all of the charges.

These are just some of the reasons health insurance companies come up with to deny or terminate your health insurance claim. At Johnston Law office we know how to address insurance companies’ bases for denying your health insurance claim, and make sure your rights are respected throughout the process of trying to reverse a denial of health insurance benefits. We’re equipped to take on the biggest health insurance companies, including UnitedHealth, Kaiser, Anthem, Aetna, Humana, HCSC, Blue Cross, Blue Shield, Cigna, and Highmark.