Whenever a medical facility provides services for patients, a request will be sent, asking to receive money for the services that were provided. This request is known as a medical claim. While many claims can be approved, it’s possible that an insurance provider could deny a claim instead. When this happens, one of your options is to file an appeal, which is a request to examine why a denied medical claim occurred, hoping the denial could be overturned. If you’ve encountered a denied medical claim, here are our tips whenever you want to file an appeal.
Know What Kind of Plan You Have
The insurance plan you have will influence the choices you make when filing for an appeal. There are a few different variants of plans you could have, which include the following:
● Individual plans: bought through the state marketplace or an insurance company
● Funded plans: employer buys plan from an insurance company. The insurance company will handle the medical expenses
● Self-funded plans: employer directly pays for the medical expenses
Determine Why the Denial Occurred
The cause of your medical claim denial can influence whether an appeal will succeed. There are multiple reasons your medical facility could receive a medical claim denial. Below, you’ll find some of the common reasons denials happen:
● Benefit is not covered
● Didn’t do coding properly
● Health plan makes you ineligible for reimbursement
Collect Evidence To Show That the Service You’re Providing is Needed
If you’re going to get money for providing a medical service, you’ll first need to demonstrate that the service you’re providing is necessary for your patient’s health. Collaborate with your medical staff and brainstorm reasons to offer a treatment or service. You might need to compile some data, like medical records, literature, or a letter from the insurance provider, to support your reasoning for receiving payments for services. When getting a file appealed, keep track of correspondents using a spreadsheet. This helps you track your tasks versus those you still need to do. Also, keep all of your correspondences, records, and notes in a single location so that you can quickly reference all of your information when filing for an appeal.
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