How to Get Medical Claims Approved by Your Insurance Company
The cost of health insurance represents a major expense for many individuals and families, so when it comes time to file a medical claim, they want to make sure that the claim is approved by their insurance company without delay. Fortunately, there are some things you can do to increase the chances of a speedy approval.
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Instructions
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Make sure all of your medical providers have complete information about your health insurance coverage. Many patients neglect to update their physician's offices when they change policies, and that can result in misdirected claims and a denial of coverage. Even if you are sure that your doctor's office has up-to-date information, present your insurance card each time you visit.
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Read your insurance policy carefully before you visit your doctor. Before you file a claim, understand your coverage--including the amount of your deductible, the cost of any co-payments and your maximum out-of-pocket costs. If you do not have a copy of your insurance policy, contact the company to obtain one. If you purchased your insurance policy through a broker or an agent, he or she will be able to get you a copy of your policy.
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Ask for a detailed copy of your bill each time you visit the doctor. Even if your doctor's office is submitting the claim on your behalf, it is important to get a copy of the bill. Having a copy of your bill, complete with all of the applicable medical codes, will make it easier to file an appeal, if necessary. Ask the front office staff at your doctor's office for a detailed copy of your bill each time you visit.
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Make copies of everything you submit. Be sure to make copies of all of your documentation, including medical bills, diagnosis codes and other supporting information. Also, fully document any conversations you have with representatives of the health insurance company.
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Follow up on the claim after a reasonable amount of time has passed. It is not unusual for there to be a delay in the processing of a health insurance claim, so you should not expect an immediate decision. However, after several weeks have passed without an approval or a denial, follow up with your health insurance company directly. Be sure to contact the company's billing department, and have your policy number and other identifying information available.
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Ask your doctor to contact the insurance company if you find out that your claim has been denied. Do not wait--ask your doctor to call right away. In many cases, your doctor may be too busy to contact the insurance company directly, but a contact by his or her representative will often help to get the claim denial reversed. If your doctor's office can provide additional information to justify the claim, the insurance company will often be forced to reverse its initial decision.
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Write a detailed appeal letter to your insurance company, and send it by certified mail. Make sure that your appeal letter includes all of the pertinent details of your claim, including the date of service, the name of the patient, the name of the physician, the services rendered and the medical code or codes from your detailed bill. Also include a copy of your bill and a copy of the denied claim. Be sure to follow up a few days after you receive notice that the certified letter has been received.
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Appeal directly to the president of the insurance company. When registering a complaint, it is often helpful to go right to the top by directing your inquiries to the president or CEO of the company in question. Doing so is a surefire way to get the attention of the people with the ability to reverse your claim denial. Even if your letter is not read by the president or CEO, the very fact that the letter is addressed to that individual will get the attention of the firm's legal department and ensure your claim gets a second look.
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Show detail about the official letter.
