Tips to Successfully Appeal Denied Claims

stressed guy David Castillo Dominici) resized 600One of the most frustrating occurrences any practice can experience is facing a denied insurance claim. While it may appear that, that is the end of the process most don’t realize that they have the option of filing an appeal. 

With the aide of Health Information Service (HIS), you and your practice will have access to expert professionals who know the appeal process inside and out. It isn’t a simple process but with persistence and an expert like HIS by your side, it is possible to overturn a denied insurance claim.

 Statistics:

  • On average, nearly half of all claims taken to the state agency are overturned.

  • It of course varies state-to-state, but when researching most advocacy organizations, you will notice that they typically report a 50%-70% success rate on overturning claim denials.

 While the process is an extended one, there are some ways to adequately prepare your group.

  1. The best thing is to put everything into writing. From here you can express that the claim is out of necessity not the reason that the company came up with to deny you.

  2. To get a reimbursement back you have to be persistent. The key is proving that your claim isn’t because of cosmetic reasons or an act of fraud.

  3. Consulting colleagues and specialists in the field is the best thing to do to make your case.

  4. Consulting higher authorities such as your state’s regulatory office is a must.

The most important step is to do your own research. If you are educated about the claim and the denial, you will be better suited to fight it. It is a long process; stay focused, stay smart and find success. The best way to stay educated about the process is to consult HIS. With the help of HIS you will be provided all the necessary tools to fight a denied claim.

It is worth the hard work to get back what you deserve.

Feel free to contact us or leave a comment below.

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Photo Courtesy of David Castillo Dominici