Secrets: Appealing Insurances

Appealing Denials and Exposing the Tactics of Insurance Companies, Attorneys and Third-Party Payers!

Delaying & Stalling

What to do when insurance companies say…

  • “It’s being processed”
  • “We never received it”
  • “We need more information”

What to do when they…

  • Ignore you, or never respond with anything
  • Write poor language on the explanation of benefits statement that splices your relationship with your patient
  • Play games with you
 DenialsHow to get paid when insurance companies deny payment with the excuse…

  • “It wasn’t medically necessary”
  • “You filed untimely”
  • “We paid the patient. Go collect from them.”
Reducing Payments   What to do when insurance companies…

  • Pay you less than what was agreed upon
  • Say your fees are “NOT USUAL, CUSTOMARY, OR REASONABLE”.
  • Say you owe them money.

What to do when the attorney…

  • Tries to get you to discount your bill
  • How can I collect the full amounts?
  • How do I better negotiate with attorneys?
  • Should I charge for medical record requests?  How much?
 What Insurance Companies Don’t Want You to Know About HMO and Out-of-Network Patients

  • How do I see HMO patients if I’m NOT contracted?
  • How much should I charge?
  • I do have an HMO contract, how do I increase my pay?
  • How do I increase my reimbursement?
  • Why saying, “We don’t take that insurance” can kill your business.
  • Do I have to verify benefits with EVERY patient?

 

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