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When Your Health Insurance Plan Wont Pay
By Kay Lowe

The very nature of managed care health insurance plans increases the likelihood of a legitimate health insurance claim being denied, or a prior authorization request is denied. Bear in mind that managed care (health maintenance organizations, or HMOs, and preferred provider organziations, or PPOs) exist for the purpose of controlling costs for the health insurance company. Many health care procedures, surgeries, durable medical equipment and drugs, particularly the more expensive ones, must have prior authorization from the health insurance plan before the plan will pay. Claims are reviewed to determine medical necessity" of the claim. Health care services or products deemed not medically necessary" will...
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