Medical Insurance Claim Denials – 7 Steps to Get Them Paid

1 Star2 Stars3 Stars4 Stars5 Stars (No Ratings Yet)
Loading...

[ad_1]

Medical insurance claims are denied for all sorts of reasons. What do you do if you feel the insurance company should have paid on a claim but has denied it?

Having run a medical billing service for twelve years, we've seen a lot of denials on claims. The largest key to getting a claim paid when it is denied is incorrectly to act on it immediately. Sometimes in a busy medical office, there is a tendency to put a denial in a pile or drawer or take care of it later, but this is a mistake. The sooner the problem is deal with, the more likely you are to get the decision reversed and the claim paid.

Here's how:

1. Look the denial over carefully. Look for a denial code that may be numbers or letters or a combination. Now search for the explanation of the denial codes, sometimes found at the bottom of the remittance. It may not make sense to you, but that does not matter. Right now you just want to know their reason for condemning the bill.

2. Once you determine the insurance company's reason for condemning a claim, you have a better idea of ​​what to do. If the reason makes absolutely no sense, call the insurance company. There is usually a phone number on the denial form. Calmly explain the situation to the customer service representative. These representatives have to deal with calls like this all day, so it is much better to treat them respectfully. Remember, if a mistake was made, it was not this person who made it; they are going to correct it for you. Be nice.

3. If you do not understand the reason at all, call the insurance company and ask for an explanation you do understand. It is very common for an insurance company to deny a claim incorrectly or because there was not enough information on the claim form. If they have denied the claim incorrectly, many times the representative can fix the problem while you are on the phone.

4. If you do understand the reason, but disagree, call the insurance company. Explain why you disagree to the representative and ask what it will take to get this claim paid.

5. If the claim has been denied for a reason which can be remedied, ask the representative exactly what you must do to correct the situation. If you are the patient or calling for the patient, this may involve calling your doctor's office and explaining to the billing manager what you have found out and asking them to follow through.

6. The representative may tell you that the claim has been denied correctly. That does not necessarily mean that they will not pay. The claim may have been denied for timely filing. If the billing office resubmits the claim with proof of timely filing, the decision may be reversed. (Incidentally, if the claim is denied for timely filing, the patient can not legally be billed.) The claim may have been denied for incorrect ID #. In this case, the ID # is corrected and the claim is resubmitted.

7. If you can not get a solution to your problem with a phone call, it may be necessary to file a written appeal to the insurance company. Ask the representative where you should send your written appeal. Explain your situation entirely and the reasons you feel this claim should have been paid. Keep copies of all correspondence and notes of all telephone conversations. Write down who you spoke to, when it was, and what they told you.

Whether you are an individual trying to get your medical bill paid or you are from a doctor's office, make sure you keep good notes of everyone you talk to or write concerning the problem. This can be the key to getting your claim paid. If you are an individual, get the doctor's office involved in helping you with your problem. Many times they know who to speak to or how to handle the problem.

Copyright 2006 Alice Scott

[ad_2]

Source by Alice Scott

Related Posts

Pet Hamster Care - Are You Up to the Challenge?

Essential Eye Health Foods For Better Eyesight

[ad_1] In many ways the saying by Hippocrates is true today: "Let thy food be thy medicine and let thy medicine be thy food." This principle can be applied to…

Read more
Dwarf Hamster Care - A Pocket Pet For You?

What Are the Serving Sizes on Keurig Coffee Makers?

[ad_1] While different models of Keurig coffee makers will have different options for cup sizes, they all have one thing in common–the buttons you press to brew a cup of…

Read more
Dwarf Hamster Care - A Pocket Pet For You?

Singing Tips and Techniques – Drop Your Adam’s Apple and Extend Your High Singing Range

[ad_1] The “Adam’s Apple” is the container of the vocal cords. When we swallow it moves up to the top of the throat in order to help keep food or…

Read more
Dwarf Hamster Health and Breeding Tips

The Advantages and Disadvantages of Being Wealthy and Successful

[ad_1] As far as I know, almost everyone wants to become wealthy and successful. Being wealthy and successful allows you to lead a comfortable life, buy anything you want to…

Read more
Dwarf Hamster Health and Breeding Tips

9 Obstacles That Keep You From Achieving Your Goals

[ad_1] While you may have spent a lot of time working on your goals for the next year, there are plenty of things that are going to get in your…

Read more
Dwarf Hamster Care - A Pocket Pet For You?

Prostate Massage – How Much is Enough? How Much is Too Much?

[ad_1] Prostate massage is without a doubt one of the most powerful tools for healing a sick and painful prostate. It's not because of the massage itself. It is because…

Read more

Leave a Reply

Your email address will not be published. Required fields are marked *

Thabet