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Appealing Insurance Claims

  1. Default Appealing Insurance Claims
    Medical Coding Books
    I am working at a Allergy/Immunology office and have problems with getting response from Ins. Co. regarding appealing and reconsideration of our claims.

    I send appeals multiples times and not getting any resolution. I feel that I am at a dead end.

    I have been working on claims back and forth for months and expediting claims as per representative instructions and when which they say give 30 days to hear from them then after submitting documents that they have requested, they come back with denial of untimely filing or it looks that they have not looked at the documentation that was submitted and denied claim.

    Does anyone knows how to deal with this and is there any information I can read or look up?

    Thank you.

  2. #2
    It depends on the insurance companies but some have third party representatives that appeals can go through if having diffuculty getting resolutions. On the back of the eob or website there should be different address for each level of appeals.
    Insurance company websites are a good way to look up the claims and to see how they are progressing.
    Each state also has a insurance commission that complaints can go through.
    I hope this is helpful

  3. #3
    North Carolina
    I have sought the help of our Insurance Commissioner and won my appeal. There were thousand of dollars involved so the effort it took to pursue this was well worth it. Depending how much money is involved, you could also seek the help from ERISA. Good Luck. This part of our job can be laboring.

  4. Default
    Thank you. Greatly appreciated.

  5. Default appeals
    Some insurance companies require you to use very specific forms or they will not consider your appeal. This is the first step towards getting them to at least reconsider. I always keep a copy of what is sent, dated and also document the information in our computer system.

    It just take perserverance.....some insurance companies are better than others to work with. We also do some appeals with phone calls to the customer service center to get items reprocessed.

    Sandy Rivet, CPC
    Northeast Cincinnati Pediatrics Associates

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