Have you just submitted an insurance claim that got denied? According to the AARP, over 200 million claims get denied each year? That's quite a few. Sometimes, it is hard to know what the next steps are after your claim gets denied. There are so many options that it can be overwhelming.
Here are five tips to learn more about your best options after your insurance claim denial.
Step #1: Take A Deep Breath
Getting your insurance claim denied is not something anyone wants to receive. However, if your claim gets denied, don't worry.
Realize that insurance is a business. There is some business reason this happened. You did not get denied for personal reasons.
Again: understand that this is not personal. Unfortunately, telling your sob story to the insurance company will not expedite this process. Keeping this in mind will help you come up with a rational way to get your claim approved faster.
The insurance company wants to see facts and money, so check for processing errors. If you have a case manager, ask them for help to come up with a game plan, and go for it!
Step #2: Find Out Why
Insurance can be very complex. There are many reasons that your claim may have been denied.
The first step is to find out that reason. Contact your insurance company or facility that you received service at. They will be able to tell you more about why your claim was denied. They have in-depth details about the claims denial.
Below is a list of the reasons your claim may have been denied,
- It is past the time that the claim is allowed to be submitted
- You have not met the medical requirements or other requirements to acquire insurance
- You did not complete the insurance information correctly or completely
- The charges are not covered by your current insurance plan
- The services you received are considered experimental
If you want to read more about why a claim may have been denied, you can read this article. It explains the top 5 reasons why renters insurance claims get denied.
Step #3: Seek Council
There are many people who want to help you!
It might be a good idea to call the hospital or the insurance company. Ask for help and see if they can get your claim reversed.
When you are talking to the experts, be curious, and help them understand the validity of your claim.
Step #4: Appeal Your Claim
A lot of the time, all it takes to get a claim revered and approved, is a letter of explanation to the insurance company.
You may need a letter of medical necessity from your doctor or hospital. Maybe you need to understand more about your claim so that you can go back to the insurance company and plead your case articulately.
Insurance companies use auditing software to help them go through all of the claims that they receive. The software is designed to save companies money. The software finds technical or billing errors.
This means that your chances of getting your claim denied increases. What this also means is that the more you apply, the better your chances of getting your claim approved is.
Here are some tips to help you when appealing your claim,
- Let them know that you are saving the company money in the future by preventing future work being done or further hospitalization
- Attach all proof that you have. Show them any records you have of the incident or medical records.
- Do not neglect your spelling and grammar!
- Make sure to file everything electronically and keep records of each step in the process
- You can always go to the human resources department of the insurance company. They can help negotiate with the insurers.
Step#5: Look Into Other Options
Insurance companies tend to come back over and over again with "soft denials" or they will request further information from you.
Understand that you have other options other than just appealing your claim over and over again.
You can request a peer-to-peer review, an external review, or appealing directly to your employer.
By requesting a peer-to-peer includes professionals reviewing your case and looking at the validity of it. This is a simple way to help everyone communicate complex needs.
An example of this is when medical professionals go to discuss the medical necessity of surgery or the medical necessity of a wheelchair or other medical items.
Everyone has the right to request an individual to review their claim. If you are going to request an external view, you need to file within 60 days of your claim denial.
Need More Help With Your Insurance Claim Denial?
Having an insurance claim denied is not something that anyone wants to have happened to them, but there's help. SafeButler puts all of the resources you need right at your fingertips.
Our blog covers everything insurance. We have blogs about life insurance, insurance claim denials, auto insurance, and much more. Additionally, the insurance learning center helps you understand all of your options and exactly what company is going to work best for you.
Remember: don't panic. Although this situation is not totally within your control, there are things that you can do to fight for your money and peace of mind. We'll be with you the whole way.
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