Insurance Denials and Appeal Process
“Justice is the insurance which we have on our lives and property. Obedience is the premium which we pay for it.” - William Penn
Dear Dr. Shocked,
Every insurance company has a timely filing date that can be as little as 90 days or up to two years. Some insurance companies are willing to process legitimate claims beyond this date on a case-by-case basis. It is necessary to appeal these claims and I would appeal all of them.
If claims did get to the insurance company and you received a denial EOB but the claims were never followed up on with a timely appeal, these need to be addressed also. There are many reasons for denials, but most denials can be appealed with success if you follow the insurance company’s stated appeal process. Often, the insurance company received the claim but it was not adjudicated in a timely fashion, causing the denial based on timely filing.
Please see below a basic template letter form to edit and use to appeal for timely filing. Using the excuse of an employee’s poor performance or lack of knowledge may be a flimsy reason, but if your practice was hit with a weather disaster like a tornado, hurricane or earthquake that shut the practice down or a personal illness or Insurance Coordinator’s illness, this could be valid for reopening a closed claim. Reaching out to the insurance company on behalf of the patient is an excellent reason because the patient is looking to the practice to file correctly. Appealing the claims is the best course of action.
Name of Insurance Company
Don’t leave your hard earned production on the insurance denial table! For further instruction, sign up for a Business Training Program with McKenzie Management’s experts.Forward this article to a friend
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