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3 Ways Persistance Pays with Medical Claims Problems

Dealing with an insurance company or a doctor and/or hospital can be overwhelmingly frustrating. Not only frustrating, but confusing. Trying to understand the rules, processes, coding, and lingo can make it so a person finds it easier to just give up the battle.

It is impossible to calculate the amount of money lost to paying bills that aren't truly owed for medical expenses. Got a medical bill or insurance explanation of benefits form that you just don't understand?

Here are 3 ways persistance can pay off big time!

1) Contact customer service at the insurance company if you don't understand the payment (or lack thereof) from the insurance company. If what you hear doesn't make sense, don't just give up. Ask again for clarification. Take notes on what was said, and if further action is needed, along with who is responsible. Mark your calendar for follow up, as indicated.

2) If you need to get action from the doctor or hospital's billing department, make the call to ask for the information that you need to get the claim considered by the insurance company. This may involve requesting medical records, or a corrected claim (ie, corrected coding for the procedure and/or diagnosis coding). If you don't get the reassurance that your issue will be expediently handled, ask to speak to the office or practice manager. Again, follow up is key, so mark your calendar.

3) Never delay in dealing with bills or insurance statements that you question. There are timely limits for appealing claims (typically, 6 months from the date of service). Putting off addressing any issues can make the difference in your option to file a formal appeal. Although, many times an formal appeal is not needed. Most claim issues can be resolved by making sure the needed information is submitted to the insurance company.

As a medical billing advocate in Loveland, Colorado, I have experienced first hand the success I have with clients by simply making the calls to the insurance company and following up to make sure everything is proceding in the right direction. With your personal commitment to following through with persistance, you can realize a significant cost savings in medical costs.

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