There are 5 steps to fixing your claim problem – but most people don’t follow them. By the time claim problems get to our office, they are usually months old, and huge issues. So here is the best way to handle it, in this order:
- Don’t ignore your mail. Read those bills from doctors, explanation of benefits and especially collection notices. Ignore these at your peril as they will only get bigger. Ignore them long enough and they will hurt your credit.
- Do Something – If the claims look wrong, if the bill isn’t paid right – do something. If you get a collection notice – do something now! Who to call? Collection notice- Call the collection company. Bill – call the hospital or doctor and find out if they submitted it to the insurance carrier.
- Call the insurance company. The numbers right on your card, easy-peezy. Except for the 45 minutes of listening to the tape of “your call is important to us…” Truth is, almost all claim problems are the result of minor coding errors and can be resolved with one phone call to the insurance company.
- Take Great Notes- Not good notes – great notes. Time you called, number you called, who you spoke to, their extension, what they said to you exactly. Especially if they tell you something is approved, or covered – we made need these later.
- Call your broker- This is a last step, because it involves a lot – you have to sign a HIPAA release form for us to look at it, then send us all your documentation and notes, and then we can discuss. If you are our client, we will usually appeal the claim for you – if it appears that things have not been processed correctly.
The appeals process has several steps, prescribed in your contract, that must be followed. It tends to be a lengthy process, often taking months. The best way to avoid this is step 1 – please read and react to your mail right away!