Health Insurance Denial

[12Jay]

Hey has anyone faced an insurance denial? Any helpful groups, resources, or services that guided you on the best way to fight it?

 

[LeeV]

Need some additional information, such as what type of insurance, what state are you located in, was there a reason, etc. Anything else that you can provide would be helpful.

 

[LostDollar]

Hey has anyone faced an insurance denial? Any helpful groups, resources, or services that guided you on the best way to fight it?

Caveat, I am NOT an insurance agent.

Are you talking about an insurance carrier denying a provider's claim for services rendered?

If so, you need to start with the insurance carrier's EOB sent to you.

This will show you the billing codes for the services the provider says you received and will also show you the specific reason's the carrier is denying the claim.

Your situation is likely not this simple, but an example.

A number of years ago, with an employer health plan, I had January claims for a service for my wife denied. When I read the EOB and discovered this, I then researched online and found that the Doctor's billing codes (I forget the technical name) for this particular service had changed in January and the provider had billed with the old code which was valid the preceding December. I called the bookkeeper at my wife's doctor's office and had them resubmit the claim with the new code, bill was paid no problem. I had to do this in two Januaries, two years in a row.

This is just my personal opinion, based on personal experience, but I think you need to know what the EOB says before you can start thinking about whether you have any grounds to appeal a claim denial.

 

[mamipapi3263]

Hey has anyone faced an insurance denial? Any helpful groups, resources, or services that guided you on the best way to fight it?

You’re probably trying to enroll in a short term or a shared plan. Call me 561-425-8141 Wanda.

 

[Yagents]

You’re probably trying to enroll in a short term or a shared plan. Call me 561-425-8141 Wanda.

So that you can create a fraudulent SEP for an aca plan?