Medical Bankruptcy Tips ? Blog Archive ? 6 Ways to Deal with a ...

A denied medical claim can be as minor as a few extra bucks on your copay or as major as a huge hospital bill. Either way, understanding why your insurance company has denied your claim and doing what you can to remedy the problem can save you some serious cash. If your insurance company has denied your medical claim, here are six ways to deal with the problem:

1. Study your policy before taking any steps

Before you do anything at all, be sure that you understand your insurance policy. If you need help with the insurance-ese in the policy, talk to your human resources department, if your insurance comes through your employer. Otherwise, get a friend or relative who is good at deciphering these things to help you understand exactly what is and is not covered, so that you know whether your claim has been legitimately denied or not.

2. Understand how out of pocket maximums work

Often times, you think your claim should go through because you?ve reached your out of pocket maximum. But out of pocket maximums only work on covered services. For instance, if you seek chiropractic care that your insurance provider doesn?t explicitly cover, the chiropractor may send a statement of treatment or a claim to your insurance company, but your insurance company won?t cover it ? even if you?ve already reached your out of pocket maximum for the year.

3. Don?t pay if insurance is pending

If your insurance is still pending but your medical provider has sent you a bill anyway, call. You?ll want to be honest with the care provider about the situation when talking. Even if the hospital or doctor?s office calls multiple times, let them know that your insurance company shouldn?t have denied the claim, and try to resolve the situation.

4. Check that the paperwork was filled in correctly

One reason that some insurance claims are denied is that paperwork is filled out incorrectly. If your insurance company isn?t covering the hospital bill for your new baby, for instance, make sure that the insurance company and the hospital both have the baby?s birth date correctly. Even the minor slip of a number on the paperwork can cause an insurance claim to be denied. Sometimes the medical care provider will let you know where the discrepancy was faster than you can get through to someone at the insurance company, as well.

5. Check and double check the bills

If your medical claim hasn?t been denied but you suspect that the insurance company hasn?t paid their fair share ? whether that?s 80% or 90% or a different percentage ? make sure you check and double check your bills. Do the math for yourself so that you can see just how much the insurance company has paid out of what they owe. Even when the claim isn?t denied, you may have to call the insurance company out on their mistake.

6. Put your appeal in writing

One article in the LA Times notes how incredibly difficult it can be to fix a problem with a denied health insurance claim. Although denied insurance claims vary from provider to provider ? ranging from 6% to 40% for six difference California managed care insurers ? it?s almost always frustrating to appeal the denied claim. While you?ll definitely want to call the insurer to see why the claim was denied, the biggest part of the appeals process is to put it all in writing and to document the entire process. If you decide that you need to formally appeal the claims denial, be prepared for a long process, but know that you can save a lot of money by appealing when necessary.

Dealing with medical expenses

One of the biggest problems of medical expenses is that they can eventually be shipped out to collections agencies. This can mean your credit taking a hit. While you might try to avoid paying medical bills until the appeals process is completed, you may need to make a choice between biting the bullet to pay the bill or taking a hit on your credit score.
If you don?t have the funds available to get this done, consider using a low interest credit card to do it. Often times with very low interest rates and a solid payment plan in your budget, you can pay off the bill before you pay lots of interest on it. You can find more information on good low interest credit cards here: http://www.creditdonkey.com/low-interest.html.
Dealing with a denied medical claim can be a frustrating process, but if you know your rights and remain tenacious while documenting everything, you can get through the process.
Daniela Baker is a personal finance blogger at CreditDonkey.

Source: http://www.medicalbankruptcytips.com/6-ways-to-deal-with-a-denied-medical-claim?utm_source=rss&utm_medium=rss&utm_campaign=6-ways-to-deal-with-a-denied-medical-claim

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