Always Send Appeals Certified Mail
by Heather M. Shand, CMAA, CBCS, CMB
When submitting an internal claims appeal to a payer for a denied claim, always use certified mail. You need to be able to track that the insurance company received the appeal. If you can’t track it, you have no proof it was sent.
Include a letter to the payer with your appeal that explains exactly why you are appealing. You need to make sure you are articulating your argument in an orderly, rationale, and reasoned way. If you have documented correctly and can articulate your agreement on paper, there should be no reason why you can capture your lost revenues. If you’re unable to state in straightforward terms why you deserve payment, don’t expect to get it.
If you did your homework, you know exactly how long the insurer has to respond to your appeal. If you do not have a response by the allowed time, file a complaint with your state insurance department. The state may ask for proof you sent the appeal—and that’s where your certified receipt comes in!