If you have a claim that is wrong it can be a lengthy process to get the claim corrected. Additionally you may need to fight with the insurance company if they have denied c overage on a service or procedure. You should begin each process with a notebook to record the results of each conversation you have with personnel.
Here's How:
First you need to call the insurance company and the hospital regarding the dispute. If you are disputing an incorrect claim then you need to request a complete copy of all services that were billed for. You also need to request that an inquiry be done into the claim. Do not be surprised if the staff is disbelieving that you did not receive the service.
Next you need to collect the documentation to prove that you did not have the service done. The sooner you do this the better. You may need your doctor to write a statement regarding this. You should also note the name of your nurses and any other information that you may need.
Wait for the results of the inquiry to come back. If they still claim that you received the service you may need to refer it their supervisor. Once you have worked through to the top level you will need to request a meeting in person to discuss the discrepancy. It rarely gets to this point. You may also need to contact a lawyer if this does not work. Keep your insurance informed during this entire process. If the claim is expensive they may assign you a caseworker to work with on this.
If you are working to have a service covered when the coverage was denied you will need to talk to both the doctor and the insurance agency. You may find that something was simply encoded incorrectly. This is a simple fix. It is often frustrating because you are dealing with two companies that have a lot of paperwork and bureaucracy to deal with. Document every phone call and the date.
Tips:
To avoid confusion on getting your bills paid you should make sure that you get all necessary procedures preapproved. Often the doctor will do this, but you can call the insurance company to make sure that it has gone through.
Sometimes a hospital is on the in-network list, but some of the doctors there are not. Anesthesiologists are notorious for this happening with them. You should contact your insurance company and the hospital beforehand to find out the options to help you pay the lowest amounts for these services.
What You Need:
- Insurance explanation of benefits forms
- Hospital bills
- Insurance policy book and contact information
- File to hold all correspondence
