The Issue

If you have an incorrect medical bill or denied insurance claim, getting it corrected can become a lengthy process. If the denial is for coverage or a service or procedure, it can mean fighting the insurance company tooth and nail…their very large teeth and extremely sharp nails.

What I Think

First of all, as noted, this can eat up weeks of your valuable time, with no guarantee of success. So before beginning, be sure it’s worth all the time it’s going to be pulling you away from your business. That said, if you’re good to go…

Here’s How:

Following is Miriam Caldwell’s About.com take on how to go about it, beginning with a notebook for recording the results of each conversation you have with the insurer or provider.  Then…

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’ll 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.

More Tips You Can Put to the Test:

To avoid confusion on getting your bills paid you should make sure that you get all necessary procedures pre-approved. 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’ll Need:

· Notebook to record results of conversations
· Insurance explanation of benefits forms
· Hospital bills
· Insurance policy book and contact information
· File to hold all correspondence

Miriam Caldwell is a freelance writer with a specialty in personal finance. She believes that you can lay a solid foundation by starting to manage your finances in your twenties.

What Do You Think? Been there, done that–or need to? Please leave a comment below to share your experience or views, or both. Have you subscribed?

Bill Willard is a freelance writer and editor in Clearwater FL. He has been a high-impact writer and editor for over 30 years. He began his “faith journey” to Catholicism in 2008 at his wife, Sue’s urging. After putting up with him for 40 years, all she had to do was ask! Visit his Website: www.writergazette.com/WillardAssociates.shtml

Or contact him at billw15@tampabay.rr.com to sign up for his popular eblog: Daily Grin.

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