Thursday, January 17, 2013

Follow Directions!

Following directions can mean the difference between getting your healthcare claim paid or denied. Every insurance company has a specific appeal payment policy that includes how to file an appeal if you're a provider or a patient. The key is to know what that policy is and follow it exactly.

Most insurance companies have their appeal policies online. Sometimes their requirements, including the appeal form, is somewhat hard to find. In many cases, they'll address appeals under their payment policies or under patient rights.

If you have trouble finding the information you need, use the search function on their website with the term, "appeal form". Most of the time that can help you quickly sift through all the information and get to what you need. If that doesn't work, call their customer service department and ask them where to find it. You don't want to just ask what their appeal policy is - you want them to help you find it on their website. The reason for this is if they give you erroneous information, you won't have anything to fall back on.

Something as simple as leaving a box unchecked, using the wrong form, or not attaching information can  cause an appeal to automatically kick out. Make sure you use the correct form and that it's completed correctly and that you have attached relevant information.

Information such as EOB's or explanation of benefits, are critical in getting your appeal processed. While it is true that they have the EOB on file and you've provided the information on the form for them find it, all insurance companies will still require this one piece of vital information.

Any other information that backs up your appeal is critical as well. Copies of your policy and/or copies of your medical records will go a long ways in proving your point.

It goes without saying that you want to keep copies of everything you submit in your appeal. This way if you have to re-submit due to a denial you only have to make copies instead of recreating the whole appeal.

While gathering all of this information seems like a lot of work, especially when the insurance company has all the information on file, it's well worth the effort in the long run. You don't want to give them any more reason to reject your appeal so do the homework and follow their instructions by submitting a complete appeal.

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