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Understand why insurance claim is denied before appeal

On Behalf of | Jun 7, 2021 | Insurance Law |

When a Nevada resident’s insurance claim is denied, it is most likely that the policy holder will suspect the insurance company is acting in bad faith. Unfortunately, insurance companies get a bad rap even when they are acting in good faith. Before jumping to any conclusions, policyholders should go through their paperwork to ensure they have not made any of the following common errors:

  1. Incomplete or missing errors in the form, including medical billing errors, delay paperwork or result in claim denial.
  2. The item being claimed may not be covered by the insurance policy, or the procedure may not be a medical necessity.
  3. The coverage limits of the plan may be maxed out.
  4. The health plan does not include the drug or the therapy being claimed.
  5. The insurance may only include in-network coverage, but the services used may be outside of the coverage.

What happens after the claim is denied?

When a policy is denied, the insurance company sends a denial notice. This notice will include information about how long the policy holder has to appeal the denial. Before filing the appeal, the policyholder should go through their insurance information to figure out why it was denied, so they can rectify the situation.

These are common reasons the claim may be denied, which is why policy holders need to be careful when submitting their paperwork. Otherwise, they may begin fighting with the insurance company when it is out of the company’s hands. Insurers facing litigation for following their policy guidelines may want to consider consulting an experienced attorney for guidance on how to defend themselves.


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