Wed 18 Mar, 2009
We all know to make sure the doctor’s office will take your Florida health insurance before making the appointment. So why is it that we always seem to get a bill in the mail after confirming this info? According to consumer advocates, more and more health plans are denying claims. Don’t panic. Many claims are rejected initially for glitches that can be sorted out rather easily and never pay a bill without making some phone calls. Claims can get kicked backed for a variety of reasons.
The first thing you need to do is get some answers. Call your Florida insurance health plan and find out why your claim was denied and get specifics. Fortunately, a good number of denials are linked to correctable errors. Claim billing is based on codes that stand for different medical problems. The wrong code entered accidentally could trigger a denial. An incorrect patient-ID number also could be at fault.
While some problems are easy fixes, others may take time and follow-up on your part to get resolved. Be sure to make a file for all of the paperwork you generate. Make a phone log with the date and time of your phone calls related to the bill including the person you spoke with and notes of the conversation. It is also recommended that you follow up each phone call with a letter, not an email, providing details of the discussion and your understanding of what is to happen next. Keep a copy for yourself just in case you will need to appeal a denial.
Remember, every health plan has a grievance process. Find out how to file an appeal and get on it right away. There are deadlines. Some plans allow you to appeal within a year of the service while others require you to file within 60 days of getting denied.
Government insurance programs, Medicare and Medicaid, have their own internal review processes. Call the programs to learn what to do.
The Medicare Rights Center is a national advocacy group that helps Medicare patients with appeals and other issues. This group recommends sending letters to your health plan via certified mail or delivery confirmation.
Florida provides another option for people in managed-care plans such as HMOs, PPOs and the like. If you lose an appeal with the plan, you can bring the case to the state’s independent Subscriber Assistance Program, or SAP. This is not an option for those on Medicare. But it can be used by Medicaid HMO clients under certain circumstances.
Finally, keep your doctor’s billing office in the loop. After all, you may need their help with additional documentation. You also don’t want the office to turn an unpaid bill over to a collection agency. The billing office may be willing to negotiate a lower payment or forgive the fee altogether. At the very least, you should be able to set up a payment plan.
The next time you need Florida health insurance quotes, visit HometownQuotes.com to receive insurance quotes for home, auto, health, life or renters insurance from local agents right in your home town.
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