Dealing with Rejection: The Insurance Way

The insurance business is a tricky one, and health insurance, even trickier. When you file a claim for health insurance, you may just receive a letter stating that your claim has only been partly accepted. You may feel a bit disappointed, but may simply file it away. This is especially true in the case of visitors medical insurance, since it is very tough to understand the way the U.S. healthcare and insurance systems work.

However, there are several reasons that claims can be rejected, and a rejection letter is not the end of the claim. One of the major reasons for rejection of a health insurance claim is clerical error, say experts. This may sound unfair, but if you think about the millions of claims filed every single day throughout the system, and the route that each claim takes, you will begin to understand the problem.

Errors can be introduced at the level of your medical care practitioner or hospital, when they fill in the wrong code for the treatment given. The error may also be introduced in the zip code information section. This means that the wrong zip code is entered for your treatment center, and exceeds the average Usual, Customary, and Reasonable rate for your type of treatment, for your particular zip code. This is usually reflected as partial payment of your claim.

If you face a rejected claim, you can request more information, and open up the lines of communication with your insurance company. If the rejection is due to an error, it is highly likely that your claim will be reviewed.