The worst nightmare for anybody to come across is knowing that his or her insurance claim has been denied. This is probably the last thing any of us want to hear especially when we have a dear one admitted in the hospital. It is extremely important to understand why our medical claims get denied by insurers. It is important to know about the different reasons also so that it can help in limiting the denials of our medical office receives. Each person residing in Dubai must read this blog. One of the best ways to prevent insurance claim denial is to be aware about the different reasons that causes denial.
Incorrect Identifier Information
One of the most common reasons why insurance claims get rejected is because patients generally fail to file a medical Claim that comprises of accurate data. You need to understand that without accurate information your health insurance plan cannot identify the patient and hence it is not possible to make payment or apply for any clean. Some of the most common mistakes that are made:
When The Patient’s Name Is Spelt Incorrectly
When the patient date of birth or other similar data does not match the details mentioned in the health insurance plan
When the subscribers name is missing
When the subscribers contact details are missing
When an individual or a patient tries to verify the benefits of an insurance before being rendered it can cause termination of health insurance.
Proper Authorization And Pre-Certification
Today many of the services are considered as not emergency related cases and hence can require prior authorization. At this time it is mandatory for all insurance papers to acquire prior authorization for services such as ultrasound or CT scan. In certain cases the patient may also require prior authorization for surgical process or procedures such as squint operation.
Exclusion Of Services
In certain cases there are medical office services that are not included in a patient’s health insurance coverage. In a case or situation like this it is important for patient to pay the hundred percent cost of these services.
Request For Medical Records
In certain cases there are insurance plans that request certain medical records. An insurance claim can get rejected when a patient fails to provide these medical records to the insurance company. These records can be the prior medical history, the physical reports, and different consultation reports of the patient, the different discharge summaries of various hospitals, radiology reports and also operative reports.