Claims Denial

SusieQ2

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Seems like all the major health insurance companies have some issues when it comes to paying claims. Most of the time when one of my clients have had an issue with claims it's been something to do with billing codes, etc.

I've never had a client that has had a claim denied except for one that went to the doctor because her back hurt after she turned her application in. (She thought that once she was approved since it happened after her application date she was good to go. I even go over that when I'm going through the application process, how long it will take, etc.)

For y'all that have hundreds of clients I'm asking is there really that much difference in companies? (I know Assurant got bashed a couple of years ago.)
 
I can count the times on one hand where one of my clients called me about a claim being denied unless it was a case where they lied on the app which only happened to me twice.
 
Most of the time when one of my clients have had an issue with claims it's been something to do with billing codes,


Coding is not a carrier issue. They can only adjudicate a claim based on the way it is filed.

You need to find a different horse to beat.
 
Oh, I totally agree on the coding issue. Personnel in a doc's office have a hard time admitting it might have been an error on their part. :laugh:
 
The only time I see issues is on the coding or if the carrier is requesting more info from the provider.

When a provider signs a PPO contract they are required to provide that information when its requested.

On my Individual block I have millions of dollars in claims each year with very little problems.

I have chosen to use just 2 companies for individual sales and both own their own network.
 
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