Content Overview
- Summary
- A Claim Denied On The Basis That The Procedure Or Treatment Is Not Medically Necessary
- A Claim Denied On The Basis That The Charges Are Not Usual, Customary and Reasonable ("UCR")
- A Claim Denied On The Basis That The Procedure Is Experimental
- A Claim Denied On The Basis That The Procedure Is Not A Covered Procedure
- A Claim Denied Due To Misrepresentation In The Application
- A Claim Denied On The Basis That The Specialist Or Facility Is Out Of Network
- A Claim Denied On The Basis That The Treatment Or Drug Is Not Likely To Cause Your Health Condition To Improve
- A Claim Denied On The Basis That You Are Likely To Require Care For A Very Long Time
- A Claim Denied For Technical Reasons Such As Incorrect Coding
- A Claim Denied Because You Are Not Home Bound
Arguments To Use Against An Insurer's Denial Of A Health Claim
A Claim Denied On The Basis That The Treatment Or Drug Is Not Likely To Cause Your Health Condition To Improve
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If the treatment or drug relates to your diagnosis, see the section above about Medically Necessary.
If the treatment or drug relates to another aspect of your health care, ask your doctor to write a letter explaining why the medical care is necessary for your total health care needs. The key should be your total health condition and health-care needs - not just a chance for full or partial recovery.
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