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Insurance Policy Review

If your insurance claim has been denied, one of the most important things that you can do is to conduct an insurance policy review. Just as the name suggests, this is a review to determine what your insurance policy entails and what services are covered under your policy. Insurance policy reviews are an easy way for members and providers to determine what benefits and coverage are available for each individual plan. Denials Management’s team of experts will gladly look over your policy to determine whether your health insurance denial was issued incorrectly or to explain what kind of coverage your policy offers.

Review for Health Insurance Denial

One of the first steps you should take after your insurance claim has been denied is to review your insurance policy. Although most individuals are unaware of this, you are guaranteed the right to receive copies of your insurance plan documents, as well as documentation related to your claim denial. In order to obtain this important documentation, you should contact the individual or organization that issued your insurance. If your insurance was issued through an employer, contact the employer and if your insurance was issued through the healthcare marketplace, contact the marketplace. Even if the person you contact is unable to provide you with a copy of your plan booklet, they will be able to direct you to where you can obtain your insurance policy.

Insurance policy reviews are crucial in helping to determine whether or not a health insurance denial was issued in error. Because health insurance carriers insure millions of Americans under thousands of plans, claims processing centers default to the most common plan language and terms when determining how to approve or deny claims, which sometimes leads to error. A few common examples of health insurance denial errors Denials Management has discovered after health insurance policy reviews are:

  • Incorrect payment amounts, including misapplied deductibles, out of pocket maximums, and out of network allowable amounts. 
  • Misapplication of preauthorization penalties.
  • Incorrect applications of plan terms and definitions, such as the definition of medically necessary services.

While this list isn’t all-encompassing, these are some of the common reasons a claim is incorrectly denied. Through an in-depth insurance policy review, Denials Management can analyze your policy to determine if your health insurance denial was issued in error and what your next move should be.

Pre-Service Insurance Policy Review

Part of our claims and policy management services also includes a general insurance policy review before you seek healthcare services. Before you seek a new treatment or provider, it’s important to understand what will be covered under your current insurance policy. You probably don’t have time to analyze every aspect of your policy and that’s okay! Denials Management will gladly look into your policy so you can understand the best path forward for you, your provider, and your insurance.

Need Our Claim and Policy Management Services?

 At Denials Management, we believe that you and your family deserve an advocate that fights for you. In addition to insurance policy reviews, we offer a variety of services designed to help you successfully fight incorrect health insurance denials. If you need our help, register today and our experts will get started on your case right away!