Challenging Insurers’ Claim Denial for the nasal airway
Why Give Up YOUR Hard-earned Money?
“… It seems that most insurers deny first and ask questions later…gambling that doctors won’t have the patience or persistence to run a bureaucratic obstacle course.”“It’s a game for them. They know that if their denials and demands for more information take up a lot of staff time, most healthcare providers will give up nor not make the effort”.
– Los Angeles Times; April 17, 2014
Why Let Your Practice Be Cheated?
The L.A. Times had the right diagnosis. Why be cheated without a fight? Better to slip on the boxing gloves and just say “We did the work, now pay up”. Multiply the lost revenue by the number of cases in which there is a denial, even if for just several hundred dollars, and you’ll realize there is big money to be mined. YOUR money.
Automate Your Appeals
- The key is having template forms with prepared documentation to support the appeal or demand for payment. After all, insurers are the masters of non-specific forms and templates. They insert the policy specifics, punch a key and out goes their letter. You know, “Dear Provider”. Do the same.
- Your template says: “Dear Insurer”. The only portions of the Claim Appeal Letter that needs “filling in” are: Insurance company name, from information, patient claim number, patient name, date of service. If other identification seems necessary, plug that in also.
- Should take less than 60 seconds and you have your Claim Appeal out the door.
- Make sure it is directed to a “Claims Supervisor” in the appeal office. There is usually a distinct mailing address for appeals as opposed to primary claims.