November 20, 2017

 

5 Simple Ways to Prevent a Denied Claim


Everyone fears it: The denied claim. Let's face it. We have all heard the horror stories on television about denied healthcare claims. These stories strike at the heart of our fears. What if we need an operation or procedure performed, and our individual health insurance company returns a denied claim? Worse: What if our son or daughter needs care, and we run into a denied claim.
 

The Secrets of a Denied Claim

As you probably imagine, the picture is more complex than television and the movies allow one to believe. In fact, providers especially do not want to see a denied claim. And there are many simple ways to avoid a denied claim, so let's explore this issue of the denied claim with an open mind. 

Healthcare providers mainly strive hard to prevent healthcare claim denials before a patient ever starts receiving care? It is a little understood fact of the healthcare industry that part of its success hinges on getting the right authorizations and verifying the patient in question is indeed eligible for coverage. 

1. Know your plan. It is important to know the health plan's requirements. Many patients do not read the handbooks their health plans provide, so they're unfamiliar with the plans' requirements. Consequently, many appeals stem from ignorance. Make sure the treatment you are planning on receiving is covered under your insurance before treatment is received.  

2. Determine if an authorization is required. Also, be aware of the authorization time limits. Know that when you receive a written authorizationon for a specific procedure, surgery or physical therapy, there is usually a “specific time frame” given with a beginning and ending date.   The authorization will not be valid and payments will not be made if you do not adhere this “window of time” listed in your authorization letter.

3. Know the maximum benefit coverage of your policy.  Nowadays there are a lot of chincy policies. Many people who believe they have adequate health insurance actually have coverage so riddled with loopholes, limits, exclusions, and gotchas that it won't come close to covering their expenses if they fall seriously ill. At issue are so-called individual plans that consumers get on their own when, say, they've been laid off from a job but are too young for Medicare or too "affluent" for Medicaid. Many of these policies limit the total coverage to $50,000.00 a year or less which is a pittance if any type of serious illness strikes.

4. Contact the doctor’s office. Before an appointment is made, call to make sure he/she still has a contract with your provider, since the web site or the printed sheet of listing physicians may not always be up to date.  

5.  If you need to be admitted to the hospital. Or go to a clinic for a procedure, always confirm that all of the medical providers [i.e. anesthesiologist, radiologist, hospital, specialist…], including the facility is contracted with your health plan.  The facility or the individual physicians may have their own billing system.  If so, they need to be contracted with your health plan to be considered as an in-network provider. 

                                                   Accuracy Makes All the Difference

On top of that, a claim needs to be error-free and accurate in order for the provider to be paid. This doesn't mean anyone inspects your healthcare claim for smudges and spilled coffee, but the facts need to be correct. Ask your doctor to check diagnosis and procedure (ICD9) codes for accuracy.  

Believe it or not, the majority of healthcare claim denials happen prior to patient care. The culprit: incomplete forms. Wrong information. A misspelled name or failure to fill out a form completely may result in a denied claim. Wrong information gathered at the registration desk has caused more than one stressful evening for a patient. 

After all, John Smith on Werner Road is not the same person as Joan Smyth of Warner Road. One single wrong letter might cause a chain reaction. The good news is that denials based on errors such as these are easily preventable. And easily correctable. 
 

   
Add A Comment
Your Name*
Comments Here*
Subject
5 x (6 + 6) =
 *Anti-spam code
 

Entries
 
Posted by Lucillereova on 10-Oct-2017 at 09:40:45 EST
Subject: free online dating hrvatska

[url=http://osexy-dating.pw/FreeDating][img]http://f70573nn.bget.ru/picture/pic00336.jpg[/img][/url] <br> <br>personal ads 300<br>desi dating 3rd<br>ant man release date blu ray<br>find a date com<br>free dating web archive<br>best free online dating no signup<br>catholic dating rules for teens<br>casual dating sites younger<br>mature singles events sydney<br>casual dating site ireland<br>spiritual dating 999<br>dating community quick<br>meet new people today<br>top dating websites besides tinder<br>most popular dating sites premium<br>executive dating your friend<br>free hookup sites that work related<br>datingsite profiel<br>date ideas by zodiac sign<br>speed dating london east<br>dating relationship worksheets<br>free singles site<br>8 minute dating nh<br>over 50 dating during separation<br>marriage agency toronto<br>singles events 9 11<br>english zulu dictionary<br>dating tips for beta males<br>find dating sites cupid<br>matchmaker game kitty<br>nz dating premier<br>meet new friends online<br>news 5 radar<br>personally effected<br>match dating website younger<br> <br> <br>catholic singles vs catholic match looking for a date in hungary[url=http://f7054002.bget.ru/totally-free-online-dating-sites-christian-august-ames/] india dating fraud u s[/url] dating search lowe's home number one dating site scammers <br>genuine casual dating site addiction interracial dating site mindfulness[url=http://f7054002.bget.ru/looking-for-dating-sites-membership-aidra-fox/] google dating 9 months[/url] single man married man date irish man <br>introductions letter matchmaking gg cs go[url=http://f7054002.bget.ru/single-tours-rita-faltoyano/] dating services townsville[/url] local singles dateline christian dating site mingle <br>romance dating irish drinking songs[url=http://f7054002.bget.ru/matchmaker-kit-vanessa-may/] us top 40 singles billboard[/url] jacksonville boat show love site dating site 94 <br>internet dating services quest free dating sites 17[url=http://f7054002.bget.ru/looking-for-dating-sites-13-mercedes-lynn/] christian singles online dating australia[/url] casual dating website 888 looking for a movie date <br>meet dating 9 months christian dating agency london[url=http://f7054002.bget.ru/htmlsitemap.htm] vietnam river boats[/url] vietnam 272 military police company blind date 2015 movie with english subtitles <br> <br>Social page: <br>[url=https://twitter.com/MonicaLeighSexy] christian online dating young[/url] <br>[url=http://brazzers-worldz.blogspot.com/] free dating nederland[/url] <br>[url=https://www.plurk.com/yourmailzzzzz] dating men behind bars[/url] <br>[url=https://www.stumbleupon.com/stumbler/yourmailzzzzz/] interracial dating richmond va[/url]

Posted by Susan Baldwin on 09-Jan-2014 at 12:16:59 EST
Subject: Head and neck cancer reconstruction

Stage IV head and neck cancer, twice. Last time massive radiation to my face which ultimately has destroyed my salivary glands and teeth. Need reconstructive work on teeth in order to chew and swallow properly as there is also scar tissue on esophagus. Insurance has denied this work, stating dental. It is not DENTAL, it is medical from the cancer treatments. Letters sent from oral surgeon, dentist, medical, oncology, etc. Still denied. If I had breast cancer, they would give me new breasts..not medically necessary to my knowledge. My teeth are. Need help!

Posted by VINENT BROWN on 21-Oct-2013 at 10:03:45 EST
Subject: Thanks

information in the web site is informative & as i am working for a providers office as medical biller. i am now in a different thought of handling insurance companiesss. Thanksssss