Medical insurance claims were rejected for various reasons. What do you do if you think the insurance company should have paid the claim but rejected the claim?
We have been running medical billing services for 12 years and we have seen many denials of claims. The biggest key to obtaining a claim when it is rejected in error is immediate action. Sometimes in a busy medical office, there is a tendency to refuse to process it in a pile or drawer or later, but this is a mistake. The sooner the problem is dealt with, the more likely you are to cancel the decision and pay the claim.
The following are:
1. Look at the denial carefully. Look for a rejection code that may be a number or a letter or combination. Now the search for the rejection code is sometimes found at the bottom of the remittance. This may not make sense to you, but it doesn't matter. Now you just want to know the reasons why they condemn the bill.
2. Once you have determined the reasons for the insurance company to condemn the claim, you can better understand what to do. If the reason is completely meaningless, please call the insurance company. There is usually a phone number on the rejection form. Calmly explain the situation to the customer service representative. These representatives must handle such calls all day, so it would be much better to respect them. Remember, if you make a mistake, it is not caused by this person; they will correct it for you. Better for people.
3. If you don't understand why, call the insurance company and ask for an explanation. Insurance companies often mistakenly reject claims or there is not enough information on the claim form. If they mistakenly reject the claim, many times the representative can resolve the issue when you call.
4. If you do understand the reason but do not agree, please call the insurance company. Explain why you disagree with the representative and ask how to pay for the claim.
5. If the claim is rejected for reasons that can be corrected, ask the representative what steps you must take to correct the situation. If you are a patient or call a patient, you may need to call your doctor's office and explain what you found to the billing manager and ask them to check.
6. The representative may tell you that the claim has been rejected correctly. This does not necessarily mean that they will not pay. The claim may be rejected in time for submission. If the billing office resubmits the claim and provides proof of timely filing, the decision can be revoked. [By the way, if the claim is rejected in time, the patient cannot be legally charged.] For the wrong ID number, the claim may be rejected. In this case, ID# will be corrected and the statement will be resubmitted.
7. If you are unable to resolve the issue over the phone, you may need to file a written complaint with the insurance company. Ask if you should send a written appeal. Explain your situation in full and why you believe you should pay for these claims. Keep a copy of all communications and notes for all phone conversations. Write down the objects you speak, the time, and what they tell you.
Whether you are trying to pay for medical expenses or an individual from a doctor's office, make sure you keep a good record or write down questions for everyone who talks to you. This may be the key to obtaining a claim. If you are an individual, ask your doctor's office to help you solve the problem. Many times, they know who to talk to or how to deal with the problem.
Copyright 2006 Alice Scott
Orignal From: Medical insurance claims denied - let them pay 7 steps
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