The Law Offices of Scott Sobol

How To Handle Insurance Claim Denials

We all know that handling insurance claims, in general, can be a tedious process of constant back and forth with support. If your claim has been denied, there are a few things you need to know in order to handle it.

If you think your claim was mistakenly denied, the first thing is to do is file a claim appeal. Now there are 3 different versions of why your claim was denied. The first one can be that it was correctly reviewed and was declined by the insurance company. The second part could be that the person handling denials didn’t have enough time to handle the claim, this can be fixed.

Now, most of the time spent on denials is basically figuring out what we can do about them which is why it’s so important to have a system in place to help facilitate this process. The third reason why denials don’t get appealed is that the person responsible for them doesn’t know how to rectify the claim.

One of the most common denials is being denied for no coverage or the coverage was terminated. When this happens you just need to go into your account and check the payment history and see if everything was paid on time. Believe it or not, most denials are errors made in the system. If that’s not the issue, then you have to look at the patient’s claim history. See if there are any gaps in the patient history that have to do with their insurance payment, if not, then it’s time to contact the insurance company and submit an appeal.

For this part, you need to make sure you review all of the emails and notifications you’ve received regarding the claim. If any of the emails or notifications are not clear, you can call your provider for more information. Remember to be persistent, this shows the insurance company that you are serious about your claim. Also, get to know the company’s appeal process, this way you make sure you’re submitting the appeal on time and any other paperwork that’s needed.

Keep a detailed record of your claim denial and the whole process you’ve gone through to see if they need to escalate the issue to a higher level. Takedown names and write down everything the insurance representatives say. Furthermore, remember that you can always ask for help. Handling the denial of a claim can be a very frustrating process, but just remember that no matter how frustrated you are, you can always ask for help.

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