What to do When Insurance Claim is Denied
What to do When Insurance Claim is Denied

What to do When Insurance Claim is Denied Image

Once a visitor has submitted claims for medical services and medications received by him, the insurance company goes through a thorough process for evaluation of the claims. This evaluation process may approve or deny the claim. For visitors it is important to pay attention before and during the claim submission process. Claim forms duly filled, necessary supporting documents attached and all these sent within time period ensures that the claims would be handled speedily. But sometimes, the claims are denied. Of course this is not a happy situation for a visitor. What’s next? Read on to understand what a visitor can do next.

When claims are denied, visitors often think the insurance company did it deliberately. This is a common mindset or myth as MCIS experience says. Visitors should keep their calm and take few preliminary steps when their claim is denied.

Preliminary Steps

1. First and foremost a visitor should call his insurance provider and understand why the claim has been rejected. He is entitled to get a thorough and detailed explanation for the reasons for the denial. Understand if your claim was rejected because of any exclusion or pre-existing condition or lack of proper and timely submitted documentation. These are few of the  most common reasons for denial of any claim.

2. The visitor must also self-introspect. He must cross check whether the service he received was a covered  in the policy or not before submitting the claim. Accordingly he must take further action.

3. If the reasons stated are not acceptable to the visitor, he can go for an appeal with additional supporting medical documents.

4. A visitor can also re-appeal after the result of an appeal process.

How to Appeal Against Denial of a Claim

An appeal is a written document stating visitor’s full name, his claim ID and outcome of his claim. The visitor addresses this claim to the insurance company and states the reason(s) why he thinks the claim should be approved. If the visitor has some new information that can be provided as a supporting document, he must submit it too along with the appeal. It should be noted that an appeal document must be submitted with additional new medical documents.  The claim officers or adjusters go through appeals and in light of any new information provided, they make sure to go through the claim evaluation process once again. Their goal is to take a thorough look at what the visitors claim(s) were and if they gave the right evaluation.

Often, after appeal the result of the claim is changed (approved from being denied), but it is also possible nothing changes. In that case, the visitor has to make a choice. He can either accept it or re-appeal.

In case of any questions regarding claim submissions and appeal process, feel free to contact friendly experienced agents at MCIS. Rejection of claim can come as a difficult moment for a visitor but it’s not easy to research and appeal. We just advise you to not panic and move ahead with information and preparedness.

Category: Visitor Insurance

June 02, 2016 at 12:48 AM

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