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 Because You Are Not Home Bound
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If your insurance covers home care, it may require that you be home bound.
Homebound does not generally mean that you are completelyunable to learve your home - or that you are confined to bed. For example, you are permitted to leave home for medical care. It is generally required that you must make a considerable effort to leave the house. There may even be a requirement that you need assistance to leave the house.
Check the precise wording of your health insurance. Ask a care provider (family member, friend, or hired nurse or aide) to write a letter describing how difficult it is for you to get around, and what is required to assist you in leaving the house. If you leave the house infrequently, it would help to describe the purpose of your trips, and how difficult they are for you.
Include the letter with your appeal form.
To Learn More
More Information
Health Insurance: Claims: Appeals: Sample Cover Letter
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