Incorrect policy number, enrollee number, or patient birth date
The claim that your physician or healthcare provider sent to the insurance company did not accurately identify who you are. This is the number one reason for rejected or denied claims and it is very common. This happened with several of Carol’s providers. Check and double check to make sure the healthcare provider knows the name, policy number, enrollee number, and birth date of the policy holder and the patient, if they are not the same person. For example, Carol once mismatched her husband’s enrollee number with her name. The insurance company claimed they had no such enrollee and the provider assumed she had no insurance. This was an easy fx once I talked to the biller at the hospital, but Carol had no idea what to look for.
Service not provided during enrollment period
Your employer buys health insurance every one to two years. Services that overlap these renewals periods are prone to errors. If your employer changes insurance companies, you have to be well aware of the effective dates and make sure your providers are well aware of the changes. If you lose your insurance and see a provider after it expires, you are an uninsured patient. This is not the end of the world. I will teach you what to do about this in the next chapter
Service not a beneft in the enrollee’s beneft plan
Your employer looks at many health plans and weighs the cost of the plan against the benefts and services included. Unfortunately, employers sometimes have to make tough decisions and cut certain benefts for the sake of others. What is even more unfortunate is that most employees, including me, never take the time to see what is included in their beneft plan until it is too late. If you get a notice from a healthcare provider or an EOB from your insurance company that states “service not a beneft in enrollee’s plan” the frst thing to do is check the beneft plan to make sure.