You recently helped your patient review a denied insurance claim for a routine diagnostic test. The insurance company stated the service was not medically necessary, even though the test was ordered by their doctor to monitor a chronic condition. This experience left you questioning how insurers determine what is “necessary” and why claims for essential care can be denied in some cases.
In your post, share your thoughts on how medical coders and healthcare providers can work together to minimize claim denials based on medical necessity. What steps can be taken to ensure that documentation and coding align with payer policies? Have you or someone you know faced a similar issue with insurance coverage? How would you address these situations in your future healthcare role?