Answer a few questions to generate a PDF of your claim file request letter.
Mail, fax or upload the completed letter to your health insurer.
Your claim file request should be fulfilled within 30 days.
If you agree to be contacted, we’ll email you later to see if you’ve received your file.
Because that’s their job. They make the process so burdensome for providers. The US insurers appear to take turns administering Medicare. So they are morally corrupt. Find a real doctor, pay cash and be well.
Ask the folks in the three branches of government about their rates of denials, their benefits and such.
They take your premium and deny your claim. That’s how they make more money.
Most of the denied things I get from my supplemental insurance are because Medicare denied something. They deny anything Medicare does so the fight to get it paid starts with CMMS.
It was hard learning but I always ASK now BEFORE any procedure, test, whatever if it’s medicare covered and covered by my secondary insurer. If the doctor/facility isn’t sure I make THEM get a pre approval before anything happens. That way I’m not gonna get burned on tests like Hep A,B, and C I didn’t need and my doctor didn’t realize how much they cost.
The whole medical claim process is contractual. The insurance people that determine what they will provide put it into a contract that the insured determines to be adequate for them and they sign. It’s as simple as that.
If you go into a medical emergency for a heart attack and decide while you’re in you are going to get your nose fixed, that isn’t part of the deal. You pay for that or you find an insurance comapny that will cover cosmetic surgery. And everythng is to support the business. If the insurance company doesn’t exist, there is no coverage of anything.
This crying over the limitation of a doctor to do work and trying to blame the HMO so they can cop out of possibly being cheated out of their pay by the public is nothing more than finger pointing. The HMO’s are up front with what they will and will not cover. And they do not cover everything all the time. Some cover more than others but you pay for that. Medicine like building a house is business. And the amount of money you are willing to spend will destine the size of the house. But that decision is yours and not the doctor’s. He is only concerned with getting paid to do services. Ask him/her if he/she would do it for half off? You’ll get your answer. And trying to mix emotion with business doesn’t always end happily. But conractual committment is solid or can be made that way.
wy69
I get a statement of services every month. Included in the package is a claim file.......... every month
Most denials are due to no preauthorization...