| We get many questions on our forum from people | | | | network (which is very unusual for this company) |
| who have gotten a denial on an insurance claim and | | | | and the other was paid to the deductible in error and |
| don't understand the denial and don't know how to | | | | was going to be reprocessed. |
| handle it. I sometimes think that we have seen every | | | | Without the phone call to the insurance company I |
| possible form of denial and then "SURPRISE" - we | | | | would have sent out two patient statements and a |
| get a new one. Many times the answer is simple. | | | | few days later would get a call from one patient |
| EOBs are all different and many are difficult to read. I | | | | saying they didn't have a deductible and we would |
| don't know how many times I have had a worker | | | | have made the call to the insurance company then. |
| ask why a claim was denied only to see that it was | | | | My point is that many times we get denials that are |
| not denied at all. It was paid to the deductible. | | | | wrong or at the very least not understood. What |
| Sometimes the deductible column is not obvious and | | | | you need to do when you get one of these denials is |
| you need to study the EOB to find it. It is not | | | | to call customer service at the insurance company |
| unusual at all to get a denial that is just completely | | | | and keep asking questions until you understand why |
| wrong. I had two today that were paid to the | | | | it was denied and what you need to do to get |
| deductible from a plan that usually only has a | | | | payment for that claim. It may have been denied |
| deductible when the provider is out of network. This | | | | incorrectly and will be reprocessed. It may have been |
| particular doctor was in network with this insurance | | | | denied for a good reason and the patient must be |
| company so it just didn't sound right. I could have | | | | billed. In order to receive payment, you must get to |
| just billed the patient but I prefer to get this fixed | | | | the bottom of the problem to know what to do |
| correctly right now if it is wrong. I called on the two | | | | next. |
| claims and found that one had a $1000 deductible in | | | | |