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Medical insurance claims are denied for all sorts of reasons. What do you do if you feel the insurance company should have paid on a claim but has denied it?

Having run a medical billing service for twelve years, we’ve see a lot of denials on claims. The biggest key to getting a claim paid when it is denied incorrectly is to act on it immediately. Sometimes in a busy medical office, there is a tendency to put a denial in a pile or drawer or take care of it later, but this is a mistake. The sooner the problem is dealt with, the more likely you are to get the decision reversed and the claim paid.

Here’s how:

1. Look the denial over carefully. Look for a denial code that may be numbers or letters or a combination. Now search for the explanation of the denial codes, sometimes found at the bottom of the remittance. It may not make sense to you, but that does not matter. Right now you just want to know their reason for denying the bill.

2. Once you determine the insurance company’s reason for denying a claim, you have a better idea of what to do. If the reason makes absolutely no sense, call the insurance company. There is usually a phone number on the denial form. Calmly explain the situation to the customer service representative. These representatives have to deal with calls like this all day, so it is much better to treat them respectfully. Remember, if a mistake was made, it wasn’t this person who made it; they are going to correct it for you. Be nice.

3. If you don’t understand the reason at all, call the insurance company and ask for an explanation you do understand. It is very common for an insurance company to deny a claim incorrectly or because there was not enough information on the claim form. If they have denied the claim incorrectly, many times the representative can fix the problem while you are on the phone.

4. If you do understand the reason, but disagree, call the insurance company. Explain why you disagree to the representative and ask what it will take to get this claim paid.

5. If the claim has been denied for a reason which can be remedied, ask the representative exactly what you must do to correct the situation. If you are the patient or calling for the patient, this may involve calling your doctor’s office and explaining to the billing manager what you have found out and asking them to follow through.

6. The representative may tell you that the claim has been denied correctly. That does not necessarily mean that they will not pay. The claim may have been denied for timely filing. If the billing office resubmits the claim with proof of timely filing, the decision may be reversed. (Incidentally, if the claim is denied for timely filing, the patient cannot legally be billed.) The claim may have been denied for incorrect ID#. In this case, the ID# is corrected and the claim is resubmitted.

7. If you cannot get a solution to your problem with a phone call, it may be necessary to file a written appeal to the insurance company. Ask the representative where you should send your written appeal. Explain your situation entirely and the reasons you feel this claim should have been paid. Keep copies of all correspondence and notes of all telephone conversations. Write down who you spoke to, when it was, and what they told you.

Whether you are an individual trying to get your medical bill paid or you are from a doctor’s office, make sure you keep good notes of everyone you talk to or write concerning the problem. This can be the key to getting your claim paid. If you are an individual, get the doctor’s office involved in helping you with your problem. Many times they know who to speak to or how to handle the problem.

Copyright 2006 Alice Scott

Alice Scott is the co-owner of a medical billing business with her daughter Michele Redmond. They currently are responsible for the billing for over 50 providers. They offer an informational website for both physician’s offices and the general public looking for information on medical billing. For more information about denial of medical insurance claims, or other information on Medical Billing, visit their website at solutions-medical-billing.com solutions-medical-billing.com

No Comments » Posted by Matt Cubb / Uncategorized

Are you a webmaster or an owner of a website? Yes, please read on. No, then skip this now.

OK, since you said you own a website, let me ask you again, “Have you lost your website/s before?”

If your answer is NO, then you are a lucky fellow. Go on and have a good life. ;o)

If YES, then you got to read this article seriously. Promise, I won’t bore you with fluffs and stuffs. It will just be 137 seconds flat read of no-holds-barred webmaster ranting on the importance of website insurance.

OK. Here we go…

For a moment, let this sentence stick to your mind.

“The risk of losing my website(s) is my responsibility as a webmaster.”

Read it again if you have to.

Good…

Sounds cool eh? Yes, the risk of losing your website is always (take note - always) on your hands. Not your programmer’s hands, not your designer’s not even with your mom. You can’t blame your webhost, your cat or your dog for this.

Why is it important for you to know that as a webmaster (as the creator and author of the website(s) you call your own), you are solely responsible to whatever success of your website(s) (and its downfall too)?

Because once you created something, you, as the creator, should have full control over it even if you delegate that responsibility on it to others.

Say you hire a webmaster or a programmer to update your website(s) for you, you are still fully responsible. If you own the site/domain and you make the last say on what to do with it, then you are still the master of it.

The concept of ownership is important here because the solution that ensures your website’s existence is in your very hands.

This is a solution that is often ignored, always the subject of pointing fingers (between you and your host or you and your hired webmaster) and yet it is your only insurance in case of website disasters.

And that solution, my friend, is simply doing WEBSITE BACKUPS.

Sorry I have to make it all CAPS to reiterate to you that it’s not only important, it’s a must have by all webmasters. It’s pretty basic and simple but the lack of it is deadly to your online presence.

Imagine if you lose your website today simply by server meltdowns, DOS attacks, hacking problems, server hard disk crashes, suspension or deletion by your host and many other disastrous situations you wouldn’t want to imagine.

Are you ready for these? Are you ready to throw away that easily years/months of painstaking work, cash and time investments and earning potentials of your website(s)?

Online catastrophes can happen anytime, even now as you read this. It’s a sad reality that we, as webmasters, have to face daily. Murphy’s law can always work against you and me, you know that.

So, do you really have backups of your websites and databases? Do you have website insurance?

Remember, we are solely responsible for your websites. Not our webhost. Not our programmer friend. YOU and ME!

And lo and behold, backups are good for your health too. Backing up your websites not only will give you security but also peace of mind. Everyone wants to feel secure and calm. I am sure you want to sleep tight at night, right? It’s cool for the soul and great for the body.

Now, do you know what to do next? Great! Go for it today.

Create your website backups now after reading this. It’s your best insurance to online success.

Manny R. Jao II is self-taught webmaster whose aim is to improve the lives and working habits of other netrepreneurs just like him. He is the developer and owner of the first automated backup software for CPanel-powered websites named CPSiteSaver which you can now download at

cpsitesaver.com cpsitesaver.com

No Comments » Posted by Matt Cubb / Uncategorized