Photo of Pamela T. Karlson and Joy Senn

Advice you need...Care you deserve.

Why are some Medicaid claims denied?

On Behalf of | Dec 14, 2020 | Health Care Planning

Every year, a number of Medicaid claims are denied in Florida. Typically, these claims are denied for a simple reason that can easily be fixed. However, some reasons for the denial are more complicated. Either way, you’ll have to go through the appeals process if you receive a denial on your claim.

What are some reasons that Medicaid claims can be denied?

Some Medicaid claims are denied simply because they weren’t filed properly. The applicant might have neglected to include important information like tax returns or other financial information. As a result, the individual can file an appeal and submit the required documentation. While rare, there are times that Medicaid claims are denied simply because of an office error.

Other Medicaid claims are denied because the individual tried to hide parts of their income during the health care planning process. For example, they might have given a portion of their savings to a friend to make it look like they had less money in the bank. If the agency figures out what they did, their claim will be rejected.

Some claims are also denied if the individual didn’t meet the income qualifications. Medicaid is only available to individuals under a certain income level unless they also have a qualifying disability or have reached 65 years of age. Additionally, Medicaid is only available to U.S. citizens.

If you’ve met all the qualifications and can’t figure out why you’ve been denied, you may want to try reaching out to an attorney. You might have to appear at a hearing to make your case for qualifying for Medicaid.

How can an attorney help you appeal a denied claim?

An attorney may help you figure out why your claim was denied, appeal the claim and submit more information if necessary. An attorney may also be able to help you receive the maximum Medicaid benefits without doing anything that might jeopardize your eligibility. If you’ve never filed a claim before, an attorney may help you through the process. They might also help you apply for veterans’ benefits and negotiate with insurance companies.