Medical Insurance Claim Denials 7 Steps to Get Them Paid
Posted on May 15, 2008 | Filed Under
Best Medical Insurance
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, weve see a lot of denials on claims. The biggest key to getting a claim paid when it is denied incorrectly is 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 dealt with, the more likely you are to get the decision reversed and the claim paid.
Heres 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 denying the bill.
2. Once you determine the insurance companys reason for denying 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 wasnt this person who made it; they are going to correct it for you. Be nice.
3. If you dont 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 doctors 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 cannot 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 cannot 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 doctors 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 doctors 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
Alice Scott is the co-owner of a medical billing business with her daughter Michele Redmond. They currently are responsible for the billing for over 50 providers. They offer an informational website for both physician's offices and the general public looking for information on medical billing. For more information about denial of medical insurance claims, or other information on Medical Billing, visit their website at http://www.solutions-medical-billing.com
Accident Medical Bills - Getting Them Paid -On Time- By Your Auto Insurance Carrier
If you are in a wreck, your accident medical bills car add up quick. In most states (not Michigan), your accident medical bills will be paid by the in...
Medical Billing - Solving the Problems Part III - Bad Insurance Filings
One of the challenges practices face is the incorrect capture of insurance information. This can happen for many reasons. First, the patient may suppl...
International Medical Insurance
International travel for business or pleasure keeps growing at a fast pace, and a slowdown is not in the cards. The most serious problem the internati...
Medical Insurance Is A Health Protection Measure
Medical costs are rising all the time and so are the medical insurance costs. However, not to worry, since there are many ways that you can get hold o...
Medical Insurance Claim Form - What You Need To Know
So you wonder, why on earth a complete article on the medical insurance claim form? Well to be honest, I wasnt sure myself until I began doing researc...
Do You Have Medical Insurance Coverage?
We all need medical insurance coverage. Although we can not always predict when we are going to need it, we can almost be sure that at some point we ...
How To Appeal When Your Medical Insurance Doesn’t Pay
Have you ever received a bill from your doctor and stopped breathing? Have you wondered why you are receiving a bill when you have medical insurance? ...
How To Get the Correct Medical Paperwork For Your Travel Insurance Claim
When you file a medical claim on your travel insurance it's important to have the correct paperwork. I suggest you review the bills and documentation ...
Cheap Medical Insurance Saves You From Exorbitant Medical Bills
Medical insurance is an important thing to consider in a life full of uncertainties. Disasters and accidents are the kind of things that strike any ti...
Critical Illness Cover - A Perfect Medical Insurance
Health survey in UK states that almost 20-25% of all people suffer from serious diseases like cancer and heart attack before they reach the age of ret...
Submitting Medical Insurance Claims Which Form Do I Use?
When it comes to submitting medical insurance claims to the insurance companies, it is important to file the claims on the appropriate forms. The mo...
Your Personal Injury Insurance Claim: Several Crucial Insights Into Medical Reimbursements
The best judge of Total Disability and/or Partial Disability is Ole Doc Comfort your attending physician. The Medical Report he executes for the insur...
Medical Insurance - Because You Need Health Protection
With the growing use of the Internet, it is getting easier to avail to different insurance schemes available in the market. Also it is more convenient...
Cheap International Medical Insurance
Medical costs around the world are skyrocketing, due mostly to the advances in specialized equipment and the cost of advanced medicines and training s...
Make Sure Your Medical Insurance Policy Has Flexible Terms
Hard times can come for anyone. Among the most difficult of all situations is when you contract a disease or when your health goes for a toss. Your he...