Health Insurance Claim Articles

Health Insurance Denied Paying For Surgery

When surgery is needed, it is typically at a high cost. Whether or not your health insurance policy requires you to have a pre-approval, sometimes referred to as pre-certification, for surgery, you should always get a pre-approval. Most likely, your health insurance policy will dictate, in very fine print, that pre-approval does not constitute a coverage decision.

While pre-approval does not constitute an ultimate coverage decision from the health insurance company, it would behoove you to obtain pre-approval in the instance that you face a health insurance claim denial pertaining to a surgery received. If you have achieved a pre-approval of said surgery, it will absolutely support your health insurance claim.

Again, whether or not your health insurance policy requires it, attempt to receive pre-approval for any medical procedures requiring surgery.

Another noticed trend in surgery: because most surgeries tend to be expensive, they also tend to be big targets for health insurance claim denials. Health insurance companies are more concerned with the overall bottom line rather than the patient.

Surgeries are often denied on medical necessity grounds. The health insurance company will typically have an in-house physician, someone who has never personally met or treated you, whether pre-surgery, during surgery or post-surgery, opine that you could have taken another medical route.

Was there a less invasive surgery available? Should you have had physical therapy before your back surgery? These are just some examples of insurance company tactics to avoid compensating their clients. This is also something that the attorneys at the Merlin Law Group can absolutely help you with.

Having dealt with hundreds of insurance claim cases, the attorneys at the Merlin Law Group are well versed in the battle with insurance companies. The intake analysis of your insurance claim is a courtesy of Merlin Law Group, and we welcome a challenge.

Health Insurance Claim Articles