Wednesday, January 2, 2013

It's All In The Detail

Any time you're billed for something that you believe you shouldn't be, details are of the utmost importance. They can mean the difference between paying and not paying. 

When you call, get the name and number of the person you spoke with. Ask if they issue reference numbers and write that down. If you're asking if something was paid by the insurance, get check amounts and numbers. If they state they received a claim, ask what was on it and write that down as well. You can never collect too many details. You never know when they may come in handy.

The same principal applies if you're appealing or disputing a claim. The first detail is whether or not your insurance company will consider your "dispute" an actual appeal, reconsideration request or an inquiry. While this may be seen as a mundane splitting of terms, it's actually critical information. Some insurance companies will only let you appeal two or three times but yet they'll let you send in an inquiry or reconsideration multiple times. We all know insurance companies rarely get it right the first time and multiple disputes have to be sent in in most cases.

Some things can be resolved by phone calls. However other times it's best to send in a dispute in writing. When you're sending in a written dispute you want to be concise and to the point. If a processor sees a long winded appeal with too many details, they'll most likely process it as a duplicate because they don't want to take the time to read it! They're cramped on time, remember?

While you need to get to the point in writing your appeal, you still need to include enough details to make it easy to understand. I always say you need to draw them a picture and assume they can't add. While that may seem comical, it's effective and you can include just enough details to get your point across.

Tools like bullet lists are handy to show the history of your claims history. You can detail out what has happened on the claim without having to say over and over again, "Then I called.... ". It's all there in order.

Another detail tool is an equation. If you're only supposed to pay 20% and you're being billed for 30% do the math for them right there on your written dispute. When things are calculated out in an appeal, the success rate goes a little higher just because the processor is not having to do the math and double check your request.

As they say, the devil is in the details. Gather as many details as you can and respond with only what you need!

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