Results 1 to 4 of 4

Need Help-Provider appeal letters

  1. #1
    Location
    Ann Arbor, MI
    Posts
    16
    Question Need Help-Provider appeal letters
    Medical Coding Books
    Good Morning!

    I am trying to write an appeal letter for my office to an insurance company. Trying to appeal their descision of a non-par status. We have patients that want service but don't want to pay OOP when they have coverage. I am new to this and don't know what facts and information that should be included in this letter.

    I called the insurance co and they just said to write a letter and send it to this address; attention to this person.

    Looking for any help, suggestions, ideas, anything. Please.

    Thank you! Have a great day!!

  2. #2
    Default
    Quote Originally Posted by Clmd1982 View Post
    Good Morning!

    I am trying to write an appeal letter for my office to an insurance company. Trying to appeal their descision of a non-par status. We have patients that want service but don't want to pay OOP when they have coverage. I am new to this and don't know what facts and information that should be included in this letter.

    I called the insurance co and they just said to write a letter and send it to this address; attention to this person.

    Looking for any help, suggestions, ideas, anything. Please.

    Thank you! Have a great day!!
    The only way to appeal non-par status is if there are no other participating providers within a reasonable geographic area - otherwise the insurer sees it as, the patient had a choice to see an in network provider, yet chose to go OON instead. There are some situations, like if the patient was visiting from out of town and is out of their home area, when you can appeal OON benefits, but it's rare. You may be stuck billing the patient on this one. Hope that helps.

  3. #3
    Location
    Ann Arbor, MI
    Posts
    16
    Default
    Thats a bummer. Thanks for the imput.

  4. #4
    Unhappy
    No problem...sorry I couldn't give you a better option. I've tried to appeal these before to no avail, even when there weren't other par providers in the same state. If the patient has an in-network PCP, you can try to see if they would give you a referral (sometimes that helps), but I wouldn't hold my breath...

Similar Threads

  1. Letters after id#
    By bearybubba2008 in forum Medicare Regulations
    Replies: 6
    Last Post: 08-29-2013, 10:22 AM
  2. Letters of Recommendation
    By cstephens63 in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 10-20-2009, 09:19 AM
  3. Consultation Letters
    By medicalsec in forum E/M
    Replies: 1
    Last Post: 01-29-2009, 05:47 PM
  4. Appeal letters for patients
    By tomtom2 in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 11-13-2008, 03:29 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.