Name: Top 4 Steps To Appealing Health Insurance Denials
1. Check your facts
You need to have thorough documentation of the health care you received. You need to know all details of your health insurance plan. It important to know what exactly is covered in your plan. Document the details about referrals and doctors you received care from. Make sure your facts are correct before pursuing an appeal. Why was the denial issued' You want to cover that reason as detailed as possible. Some reasons are that the procedure wasn't explicitly covered, the procedure was not medically necessary or the procedure was experimental. Gather as much information defending yourself as you can.
2. You will need help from your Doctor
Your doctor needs to be on your side, especially with regards to documentation. You must be patient and make it as easy as possible for them to help you. Doctor's office staff are often overwhelmed with requests, you cannot get frustrated in the process.
3. Star the appeal
Read through the documentation and understand the process as clear as possible. When writing it, make the details that are important as underlined as possible. Include recommendations from physicians to oppose the initial reason the claim was denied. Remember to bring supporting evidence and quotes from medical records. It is smart to include direct quotes from your doctor and insurance plans if possible. Photo copy each piece of documentation that will be sent to the insurance company, because these tend to reappear later in the process.
4. Use your state's Department of Insurance to find help to handle medical insurance denials. Many have hotlines that provide assistance. The information could be basic or extremely helpful. In addition, they are equipped to help with specific denials. If you do want to get legal help, consider that the cost of the denial outweighs the legal costs. A lawyer will generally give the most honest advice.
Date Posted: 2017-06-15