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Denied Medical Claims: What You Should Know

amrambulance

From Wikimedia

Having medical insurance provides great peace of mind to countless Americans. While we all want ourselves and our families to have a healthy future, there are times when life throws us a fast one, and we need professional medical care without leaving a massive dent in our bank accounts. Sadly, it’s not all that uncommon for people to have their claims denied when they need them most. If this has happened to you, here are some important things you should know.

Why Your Claim Was Denied

There are a lot of different reasons why an insurer will deny a claim. Naturally, the first thing you need to do is find out why yours wasn’t pushed through. As soon as you receive your statement of benefits, you need to call your hospital, insurer or doctor to ask about the denial. You may be lacking pre-certification or authorization. You might have run over the timely filing limits, failed to capture the appropriate tests or procedures, or may have been deemed to have insufficient necessity. Whatever the answer is, bear in mind that many of these kinds of denials are reversible with the application of the proper tools. It’s reported that around half of all claims that are independently denied have been successfully appealed.

How To Get Help from Advocates

doctor_talking_with_a_patient

From Wikimedia

Though it may not feel like it, you’re not alone when you have your medical insurance claim denied. Various doctors, medical institutions, and even the insurance companies themselves, can give you assistance with reversing your denial. A lot of hospitals will even hire social workers who are trained in obtaining benefits for those that qualify, and negotiating with insurance companies that have denied a person’s claim. In a lot of cases, they’ll be linked with the charity care department of the hospital. Some patients, who can’t get reimbursed by their insurance companies, will be eligible for charity care to assist them with simply paying their bills. If it comes to it, you may need to hire a lawyer who works with insurance cases, like Diane A Nygaard, P.A. Whoever it is you deal with, be sure to explain your case in detail, and stay polite and engaging.

File Everything Electronically, and Make Sure You’re Keeping Records

When you’re fighting a denied claim, you need to keep a digital paper trail covering all your dealings and communication with people involved. This has made all the difference in a lot of cases like this. All of the correspondence between you, your doctor, your insurer and higher-ups at your hospital or clinic should be done by email, and archived so that you can fall back on it if needs be. When you’re trying to get to the bottom of your claim in the first place, be sure to ask detailed, specific questions. If anything’s ambiguous to a third-party reader, it can really get in the way of recovering your denied claim. You should also ask questions about the process through which your claim was filed, and ask for copies of the filing. The more diligence you exercise, the faster and easier it will be to get your claim pushed through.

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