Six common reasons claims are denied

Reason 1: Doctor Error

Doctors make mistakes. Frequently, they write in the wrong
insurance code or make another error on the insurance form,
McKechney says.

Reason 2: Pre-existing Condition

Pre-existing conditions are one of the most common reasons that
insurers deny coverage. Sometimes claims on this basis aren't
really denials. The insurer needs more information from your doctor
or the hospital, says John Clark, a partner in the Atlanta-based law
firm Clark & Mascaro. Other times, the claim is denied because it
doesn't conform to the policy's actual language. For instance,
Clark questions whether the policy specifically requires that the
condition be diagnosed and treated for the "pre-existing" clause to
apply or whether simply having the symptoms is enough.

Reason 3: Bad Processing

Sometimes Medicare errs in processing claims. In such an
enormous program, McKechney observes, the margin for human
error is wide. Errors easily occur because Medicare claims are
administered separately in each state, and each claim is filed in
the state where the health care was provided. However, claims
sometimes are re-routed because a number of seniors divide their
time between separate residences in different states, according to

Reason 4: Not Medically Necessary

Frequently, insurers rule that a service or procedure was "not
medically necessary," Clark says. In reality, the person who
reviews medical claims usually works for the insurance company,
has never seen the patient and probably is not a health-care
practitioner, according to Clark.

Reason 5: Noncovered Benefit

Another typical explanation is that the care you received was a
"noncovered benefit." Insurance policies always include a list of
services that are and are not covered. Often the definitions of
benefits are so vague that it's difficult to compare your situation
with the policy's medical terms, according to Clark.

Reason 6: Out of Network

An insurance company may deny your claim by contending that
you used an "out-of-network" doctor or hospital. Sometimes a
medical emergency may prevent you from getting treatment from a
health-care provider who is part of your insurance plan, according
to Clark. Or you may need a specialist for a certain condition, but
there is none in your area.

Source: Web MD 

Reason 7
Genetic Prejudice!!!!!!!!!!<A Future Horror about to Unfold!!>