Many with health insurance, at one time or another, have probably had an insurance denial. Those can be frustrating, costly and even deadly. In a recent Market Watch article it was noted "In ... six Medicare Advantage plans covering more than 23 million members, there were more than 1.9 million denials. Only 7% appealed their denials - but for those who did 66% of those denials were overturned." They suggest the following appeal tips:
1) Get a written copy of the denial letter and look for the specific reason cited for the denial.
2) Appeal every denial in writing. Provide specific information that counters the reason they cited.
3) Ask your physician’s office to submit an appeal on your behalf and get a copy for your records. This is not duplicative; your appeal letter is complementary to your physician’s.
4) Track deadlines aggressively. Both initial decisions and appeal reviews are subject to regulatory time frames that insurers are required to meet.
5) If your appeal is denied, escalate to your state insurance commissioner. Regulators notice patterns.
Footnote: GO Medical does not bill Medicare or any other insurances but if one needs disposable urology, ostomy, wound care or incontinent supplies that are denied we offer discount self pay options
Some private health insurances will approve claims submitted by subscribers from providers outside their network. Each private insurance policy is different and if one is considering submitting a claim themselves it’s best to contact one’s individual insurance policy before submitting a claim. In addition, some with high deductibles and co-pays find self pay a less expensive out of pocket option.