http://www.medicalclaimshelp.org/home1.aspx
from above link:
“Sometimes getting a medical claim paid correctly can be a real battle. It starts when a charge that should be covered is denied. You call customer service, and they tell you that it will be reprocessed. Then, in a few days, another denial arrives with a brand new denial code. You call again. It’s denied again. And it may stay that way if it’s stuck now in this health insurance claims adjudication netherworld where nothing is paid easily, if at all. “
Recently a clinic manager told me; “Resolving wrongly denied medical claims used to be a simple process. A biller working in our office would stamp “APPEAL” in big red letters on a photocopy of the claim, and mail it back to the insurance company. These days, you’d be wise to put the cost of that postage in the bank, and throw away both the APPEAL stamp and its red ink stamp pad because it won’t even make it past the insurance company’s initial computer screening. They’ll toss it into the trash and you’ll never hear anything back from them. Today, you need to get your ‘A-game’ on. Otherwise, you won’t see a penny.”
Our insurer denied an appeal in a way that made it very clear their people were either stupid, ignorant or blind. I chose blind.
In my response, I suggested the Stevie Wonder and Ray Charles, their Nurse Practitioner and Appeals specialist be replaced with someone who can see and therefore be able to read.
I’m sure that one’s hanging on a wall somewhere. Of course, it was ignored.