Health Insurance is great when it works, but when your claims get denied, it can be extremely frustrating. The good news is that you can probably get the denial fixed pretty easily; the bad news is that denials are becoming more frequent for everyone.
I work on many claims weekly, and have dealt with nearly all of the New Jersey insurance carriers in getting them corrected. I’ll give you the basics on how to get “most” denials fixed and paid for.
Stage 1
In my experience, most claims are denied because of missing information, incorrect information, miscommunication, or some other billing error. That is good because you can generally get these corrected within a call or two to the insurance carrier and the billing provider. For these, call your insurance carrier and physician and get whatever needs to be corrected, corrected. Be sure to write every single thing down including names of people you spoke to, reference numbers, dates called and all correspondence regarding the claim just in case.
Stage 2
At this point, some of you that thought you were done in Stage 1 are still fighting the same claim. Persistence counts so make the phone calls again and be sure to reference everything you have written down up to this point.
If you are in a situation where it wasn’t an easy fix, I recommend getting a copy of your insurance contract to review plan provisions and make sure things were processed correctly and according to the plan documents. If they were not, get ready for you first appeal. The contract will tell you how to go through this process.
Stage 3
Yep, some of you will still be working on the same simple issues. Keep persisting until it is fixed!!!
If you filed your first appeal and it was denied, proceed to the 2nd level appeal as directed in your contract.
Stage 4 and Stage 5
Repeat Stage 3 until you are done.
I know I haven’t revealed anything magical about how to get claims fixed, but the truth of it is that it comes down to persistence, documentation and follow-up. If you aren’t comfortable going through the process, you should employ the help of your insurance broker as early as Stage 1 so they can assist. If your broker can’t or won’t help, call me and I would love your business and the opportunity to help.
Correcting Your Health Insurance Denial to Get your Claim Paid Fast.
Before I get into the process, the most important thing is to document everything including times called, keep copies of every correspondence, reference numbers and everything else pertaining to the claim.