How are you at handling your medical bills? Maybe you think you’re pretty good at it. You know what your co-pay is. You always wait to receive your explanation of benefits before you pay your bill at the doctor’s office. Truth be told, you’ve got this whole healthcare thing down.
What happens, though, when you receive notice that your medical rejection has been rejected? Have you ever realized how much larger your medical bills are when your insurance doesn’t pay a portion of them? Suddenly, you don’t feel so in control of your healthcare costs.
Before you panic over the high balance left unpaid on your medical bill, rest assured that this notice is not the final word on your medical claim. There are several steps you can take to find out why your claim was denied and correct any mistakes. Take a minute to calm your fears and then start working your way through these suggestions:
Inspect your explanation of benefits for errors. One of the most popular causes of a denied claim is an error in claim information. Your doctor’s billing office has to input a great deal of information when billing your insurance company, and mistakes sometimes happen. Check basic information such as your name, your insurance information (sometimes claims are submitted to old expired insurance companies instead of the patient’s current insurance company), and your date of birth. If you find an error there, call your medical provider. They can correct their error and re-submit the claim with the appropriate information.
Call your insurance company’s customer care center. The customer service folks will be able to explain to you exactly why your claim was denied. In some cases there was just an error in processing, and your claim can be corrected. In other cases, you may have received a service that wasn’t covered by your insurance. Either way, you will need to know why your claim was denied before you can escalate your claim to an appeals department.
Write an appeal letter. On your explanation of benefits, you can usually find the address of your insurance company’s appeals department. You will need to submit a letter appealing the initial decision of their claims department. In this letter you should explain why you believe the claim should be honored. Provide documentation supporting your stance on the matter: letters from your provider, copies of your medical bills, and any information about pre-authorizations you might have requested are all great things to include. Take care to be timely with your request; your insurance company will limit the length of time you can appeal their decisions.
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