Question

1. In what way has the United States dealt with one of the most contentious ethical issues in health care: when and where patients can take action if they feel a health insurer wrongly denies them coverage and, as a result, causes them harm? (250-word min), (APA reference)

Answer 1

Ans) When the insurance company denies a claim because of unfiled documents, you may submit these within the specified period of time. If you used the services of a TPA, you must seek their involvement to help fight the rejection. You may need to file an appeal through a health insurance claim denial appeal letter.

- Common medical coding and billing mistakes that cause claim denials:
Coding is not specific enough.
Claim is missing information.
Claim not filed on time.
Incorrect patient identifier information.
Coding issues.

- There are several reasons insurance companies deny claims that are valid and reasonable. For example, if your accident could have been avoided or if your conduct led to the accident, your claim may be denied. An insurance company may also deny a claim if you have engaged in conduct that renders your policy ineffective.