How to Dispute a Medical Claim Denial

To dispute a medical claim denial, you will first have to understand why the medical claim was denied. Medical claims denials are often the result of billing errors, such a misspelling of a patient's name, an incorrect Social Security number or an invalid procedure code. Because medical insurance companies are very particular about how medical claims are submitted, it is imperative to ensure that your medical information is accurate and up-to-date.

Difficulty: Moderately Challenging

Instructions

1. Have your explanation of benefits readily available to easily access the information you will need to dispute a medical claim denial with the insurance representative. Your insurance company will mail an EOB each time a medical facility files a medical claim for an office visit or hospital inpatient or outpatient service.

2. Contact the insurance company using the telephone number provided on the back of your insurance card. Once you are connected to a representative, you will need to provide him with information from your insurance card, such as your group number and policy number; each medical insurance company is different so the requested information may vary.

3. Inform the representative that you are calling to dispute a medical claim denial. The representative will need the date of service of the medical claim you want to dispute; this information is located on your EOB.

4. Write down all pertinent information on the bottom of your EOB that the medical insurance representative provides you with. Include the date you spoke with the representative, the reason the insurance the company denied the claim and the name of the representative.

5. Contact the medical billing department that filed the medical claim. Have the bill department representative update any incorrect information used to file your medical claims, such as your social security number, date of birth, full name and policy number. Have the medical billing department check the procedure code for accuracy; this is very important to ensure you are not being billed for procedures you did not have performed.

6. Request that the billing department resubmit the medical claim to include any updated information for approval. The billing department will resubmit the medical claim on your behalf and you will receive an updated EOB; it will include the date of service, the date filed, procedure code, policy number, insurance benefits percentage paid on the claim and any monetary obligations you are responsible for, if any.

Tips & Warnings

• Be patient during the resubmission period; it may take several weeks to get the issue resolved.

References

• Avoid a Health Insurance Denial

[sunnyglitter]

on 8/5/2009 I actually need to do this. 5*