If your medical claims have been denied by your health insurance company, what are the best strategies for fighting and appealing the medical claims denial so you do not pay out-of-pocket?
What happens when you have already received a medical procedure, like surgery, or you have already participated in a rehabilitation program for a mental illness or for drug and/or alcohol abuse, and then your insurance company denies your medical claims, leaving you with potentially thousands of dollars to pay?
What are the best strategies for fighting denied medical claims? Can you do it on your own?
It is important to first check all claims information for possible clerical errors such as an incorrect address, either yours or the medical professional or facility, or the mental health or substance abuse treatment center. Also, a doctor, counselor, or anyone working in one of the facilities may have inaccurately documented the procedure, diagnosis, or treatment code.
Double-checking all of this information can painlessly find the mistake that can be easily corrected for a then accurate medical claim.
If an error was not made, and the claim is still being denied, there are strategies to combat the insurance company’s bill you should not be paying.
Most health insurance companies have a claims appeal policy in place as an option for those whose medical claims have been denied.
- Check your insurance plan’s Explanation of Benefits (EOB).
- The document or online list, outlines everything that your plan covers, and the applicable copays or financial components that are your responsibility.
- Ideally, read through all benefits when you sign up for a plan, and double check the EOB before agreeing to a procedure or treatment program to ensure coverage.
- Research the denial code applied to your claim.
- Find out how much time your insurance company allows for denied claims appeals to be filed.
- Formulate an argument, or justification, for why your claim should be approved.
- Request a letter from the doctor, counselor, or other medical or mental health professional who provided the service or treatment, explaining why it was necessary and not experimental.
- You want to create a paper trail as opposed to communicating over the phone.
- Hire a third-party entity to handle the appeal process for you.
- Save yourself the headaches and stress that the denied medical claims appeal process can cause you.
- With medical billing and medical coding specialists who do not work directly for the health insurance company, you know that the third-party company’s employees will do everything they can to get your medical claim denial appeal accepted.
With continuous follow-up and medical claim appeal maintenance, a third-party company will track the progress of your appeal from beginning to end. The company does not have a financial investment in denying your claim or paying for less than they should, as is true of your health insurance company. An outside vendor will determine what you should be paying, what the health insurance company, should be paying, and the overall appropriateness of your appeal of the medical claims that your insurance company initially denied.
Featured images: License: Image author owned
[author] [author_image timthumb=’on’][/author_image] [author_info]Kenneth Smith is president and founder of A-Fordable Billing Solution a Pasadena based medical billing company helping individuals and health care providers deal with medical claims.[/author_info] [/author]
