Health Care Claims Denied

Why Healthcare Claims are Denied and How You Can Prevent It

Everyone fears it: The denied healthcare claim. Let's face it. We have all heard the horror stories on television about denied healthcare claims. These stories strike at the heart of our fears. What if we need an operation or procedure performed, and our individual health insurance company returns a denied claim? Worse: What if our son or daughter needs care, and we run into a denied claim?

As you probably imagine, the picture is more complex than television and the movies allow one to believe. In fact, healthcare providers especially do not want to see a denied claim. And there are many simple ways to avoid a denied claim, so let's explore this issue of the denied claim with an open mind.

The secret about denied claims

Do you realize healthcare providers strive hard to prevent healthcare claim denials before a patient ever starts receiving care? It is a little understood fact of the healthcare industry that part of its success hinges on getting the right authorizations and verifying the patient in question is indeed eligible for coverage.

Accuracy makes all the difference

On top of that, a claim needs to be error-free and accurate in order for the provider to be paid. This doesn't mean anyone inspects your healthcare claim for smudges and spilled coffee, but the facts need to be correct.

Believe it or not, the majority of healthcare claim denials happen prior to patient care. The culprit: incomplete forms. Wrong information. A misspelled name or failure to fill out a form completely may result in a denied claim. Wrong information gathered at the registration desk has caused more than one stressful evening for a patient.

After all, John Smith on Werner Road is not the same person as Joan Smyth of Warner Road. One single wrong letter might cause a chain reaction. The good news is that denials based on errors such as these are easily preventable. And easily correctable.

Fill in and review

Here is good advice. When you or a loved one seek healthcare, carefully go over the materials you are filling out. Fill them accurately. Fill them out completely. Granted, it may not be easy to think clearly in the midst of a crisis. But ask the receptionist for the form later. When you are in a calm frame of mind, carefully re-check the form. Preventing a denial is easier than you think.