- Helping you resolve Provider billing problems and claim denials
Items we need from you:
- Bill/Statement from Doctor’s office or facility
- Explanation of Benefits (EOB) from your insurance plan/carrier
- Medicare Clients Only: Medicare Summary Notice (MSN)
- Authorization to speak to your Provider
First thing we will look at is:
Did your Provider/facility submit the claim to your insurance company?
If not, Why?
Did they have your insurance information correct?
If the answer is No, we will instruct your provider to resubmit the claim to your insurance company with the correct information.
If it went through your insurance, things we will investigate:
Is the provider in your plans network?
Was it a covered service? We will review your Summary of Benefits
For Medicare Clients – Does Medicare cover this service?
Have you met your Part B Deductible?
Did it process correctly?
Was it coded correctly?
If we/you have tried unsuccessfully to resolve the billing dispute or denied claim informally through phone calls or written letters, we/you will have to file a formal appeal with your health insurer. Each plan handles appeals differently, so we will need to review how your plan for the appeal process.