Tricks Companies Pull With Health Insurance Coverage

When you pay your premium for health insurance coverage, you expect to be covered for health insurance costs. However, many times your claim will be denied.

Pre-existing Conditions

There is very little that you can to protect yourself from a “pre-existing” claim. Whenever you switch to a new insurance company, you are at risk of running into this problem. When a new patient comes into a clinic with some sort of problem, the insurance company will claim that the condition was already there before their individual health insurance coverage began.

People run into this frequently when switching jobs because they are no longer on their old company's plan. One way to combat this is to get temporary health insurance coverage. Many companies that offer this will help form a bridge to your new health insurance coverage.

Pregnancy is another condition that will often be denied because of the pre-existing disclaimer. Maternity health insurance coverage is important as the price of having a baby keeps going up. Be sure to get all of your conditions taken care of before you switch providers.


This is another common trick that most doctors and insurance companies use. They will not let you see the professional that you need unless you are referred to them. For example, say that you think you have a hernia. You know that in order to resolve the problem, you will have to see a general surgeon. However, you cannot see one unless you are referred by another doctor. Therefore, you have to pay a deductible to the first and second doctor to get a resolution. These fees can add up after a few visits. 

Prior Authorization

Many insurance companies will completely deny your claim if it was not pre-authorized by them. If you do not call ahead and get an authorization from your insurance company, the bill for your service will fall back on you. While this makes sense in the event of a large procedure like surgery, insurance companies have started taking advantage of it on smaller procedures as well. 

Statute of Limitations

Putting a time limit on the amount of time it takes your claim to be filed is another common trick that insurance companies love. If your claim is not filed within a certain amount of time, they will not pay it. Each provider is different, so be aware of what your company's rules are. If your doctor's office forgets to file the claim or loses the paperwork, you will be stuck with the bill. If you stay on top of the process, you will be much less likely to pay out-of-pocket expenses. 

Insurance companies have a tight hold on the industry and have several legal methods established to deny your claim and coverage.

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