Fighting a Denied Claim from an Insurance Company

Probably the most common occurrence of a denied claim are those involving health insurance. If this happens to you, don’t take it laying down, fight for a resolution of your claim. You might be surprised at just how far you can get.

Steps To Fight A Claim

The first step is to fully understand why the claim was denied. If you are not satisfied or don’t understand the notice sent to you, call the insurance company and talk to them until you understand. Now review your policy and see where the exclusion is. Even if your service is not covered, look for exceptions you can use.

Make sure you keep detailed records about all things associated with your claim. Note down the date, time and who you spoke to and their position each time you contact the insurance company. Write down what they tell you to do and then write down what you did in regards to those instructions. The more detailed the better.

Appealing a Claim

Sometimes a denied claim is simply a clerical error. Medical billing is an absolute mystery to most including many doctor’s offices. An incorrect code on a billing statement sent to the insurance company can result in a denial. That’s why it’s important to understand why the claim was denied. If it was denied for a service not rendered, then a call to your doctor’s office could clear the whole thing up.

If you have to appeal, don’t hesitate to contact a patient advocacy group for assistance. Your doctor’s staff can also be helpful as they have a history with the insurance company and know how their billing system works. Finally, the insurance company itself may have an advocacy program.

Don’t forget to keep unpaid physicians in the loop. Explain to them why they have not been paid. This group may also have helpful information on how to collect. But in any case, keep them informed so they don’t think you are a dead beat.

This article is for informational purposes only, not as replacement of a sound legal opinion.

Learn more from www.weinstein-law.com – Fort Lauderdale law firm of Weinstein Law.