6 doctors weighed in:

What is the main reason for denial of insurance claim?

6 doctors weighed in
Dr. Francisco Agullo
Surgery - Plastics
4 doctors agree

In brief: No medical necessity

Most common denials are due to lack of documentation by the doctor of medical necessity.
Some procedures are not included as benefits in insurance plans (cosmetic surgery).

In brief: No medical necessity

Most common denials are due to lack of documentation by the doctor of medical necessity.
Some procedures are not included as benefits in insurance plans (cosmetic surgery).
Dr. Francisco Agullo
Dr. Francisco Agullo
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Dr. William Kirsh
Family Medicine

In brief: Coverage not in plan

The major reason for denial of health insurance coverage is mostly due to administrative issues between the provider of service and insurance carrier. For example: 1.
Incorrect patient identifier information on claim form; 2. Coverage terminated by the employer group; 3. Requires prior authorization or precertification; 4. Services provided is a “non-covered” service under the insurance plan;.

In brief: Coverage not in plan

The major reason for denial of health insurance coverage is mostly due to administrative issues between the provider of service and insurance carrier. For example: 1.
Incorrect patient identifier information on claim form; 2. Coverage terminated by the employer group; 3. Requires prior authorization or precertification; 4. Services provided is a “non-covered” service under the insurance plan;.
Dr. William Kirsh
Dr. William Kirsh
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