Health Insurance Claim Denial Lawyer in Monona Grove
How do I appeal a health insurance claim denial in Monona Grove?
“Appealing health insurance claim denial” is a mouthful, and to many people, a very intimidating and scary process that conjures up images of mountains of paperwork and calls to your health insurer. The truth is that appealing a health insurance claim denial can be a very straightforward and worthwhile process if you know what you’re doing---and if you have an experienced health insurance claim denial lawyer in your corner if your medical claim denial turns into an insurance dispute.
Review your Explanation of Benefits.
Your Explanation of Benefits, or EOB, is the key to appealing health insurance claim denial because it gives you the reason for the medical claim denial, which could include:

• Coding error or omission;

• Patient information inaccuracy;

• Health insurance claim sent to the wrong health insurance company (i.e. eye exam sent to medical insurance instead of optical insurance, sent to a previous insurance company that does not cover you now);

• Required preauthorization or authorization was not obtained; Treatment is deemed unnecessary or excluded from plan; Health insurance coverage expired;

• Insufficient information about the service;

• Any other reason specified on EOB.

Your Explanation of Benefits also contains the process for appealing health insurance claim denial and the number for the health insurance company, who you will need to contact for more information about the medical claim denial, to resolve the issue, or to initiate the medical claim denial appeal process.
Contact your health insurance company.
Use the number on your Explanation of Benefits or on the back of your health insurance card to contact your company. It may take numerous calls to resolve your issue or to get the information you need, so make sure you document the name of the representative on the phone, the date and time of the call, and information provided by the representative. Don’t be afraid to ask for a supervisor if you find the information provided by the representative about your medical claim denial insufficient.

If your health insurance company needs more information about the service provided, don’t hesitate to contact your doctor or medical facility to request further documentation; often they can send this documentation directly to your health insurer. For coverage information about an employer-provided insurance plan, contact your employer’s human resources office to resolve any minor coverage issues. Some employers may also provide a health insurance medical claim resolution service that can assist you with appealing an insurance dispute.
Collect documentation for your appeal.
The next step is to collect documentation for your appeal. The nature of the documentation you collect is dependent upon the reason for the medical claim denial. If the reason for your medical claim denial is that the service or treatment was deemed unnecessary, contact your doctor for supporting documentation and information, such as a letter, detailing the necessity of the medical treatment for your health. Follow the appeal process to the letter when appealing a health insurance claim denial.
Consult an experienced health insurance claim denial lawyer.
If your health insurer denies your appeal, and the amount of your health insurance medical claim warrants a consultation, contact an experienced health insurance claim denial lawyer. While not every medical claim denial is made in bad faith, a health insurance claim denial lawyer can give you legal advice and help resolve your insurance dispute.

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