How To Appeal An Auto Insurance Claim

How To Appeal An Auto Insurance Claim – First the obvious. It is a psychological term often used to describe a natural defense mechanism where we ignore feeling uncomfortable.

Second, it is a term best described as one of a medical organization’s worst nightmares. You see, the second meaning of denial in healthcare occurs when an insurance organization does not accept services provided by a physician.

How To Appeal An Auto Insurance Claim

Sure, you could say I’m a bit melodramatic. After all, experienced medical billing professionals will be the first to tell you that some rejections are less of something you can avoid and more of an inevitability. They have a point.

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There are thousands of different reasons for rejections out there and just as many if not more techniques to implement within your organization to prevent them. However, that bit is beyond the scope of this particular blog post.

Since many professionals see them as an inevitable part of the medical billing landscape, what can you do when your office receives one?

After all, if you performed service on a patient…your organization deserves to be paid. Still, the medical claims denial landscape is bleak for today’s healthcare facilities. A recent study found that rejection write-offs average 53%.

Such a high speed is not something many organizations can afford, leaving smaller practices with a difficult decision to make.

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Not only are you at a disadvantage already from a statistical point of view when it comes to denial of medical claims, but also from a time perspective.

You see, the majority of doctors already state that they need at least 50% more time with patients. No wonder burnout is ravaging the healthcare landscape.

In other words, those statistics prove that facilities don’t have time. And if these organizations had more time, they would allocate it to their clients. I don’t blame them…that’s why these places exist.

Anyway, the point I’m trying to make with all of this is that while getting paid for a claim from an insurance provider helps keep the lights on, it doesn’t take precedence over the client’s time.

Appealing An Auto Insurance Claim Denial

All of this mess leads us to the statistics from earlier that pointed out the average rate of claim denials.

So if time is the leading factor in why your organization is not sending appeal letters for your medical claim denials, what should you do?

This first sample appeal letter from Mt Home Arts is just that, a template. Every time you receive a medical claim denial, there is data that you will always get back, such as…

Now that’s not a lot of data but that’s all you need since you already have all the additional information available.

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Plug what comes back from the insurance company and the information you already know into your appeal letter template. Before you know it, you’ll have all your rejections ready for resubmission in half the time it took you to set up a template.

For healthcare providers, branding is often an afterthought. I’m not trying to call you out if you fall into this majority, it goes back to what I said earlier. Your first priority is to provide care to your customers.

Not to mention the fact that often a doctor’s name and title carry enough weight in most eyes to know that anything sent from them is important.

In other words, while being a doctor is a great achievement that leads to a certain level of respect, it will not give you any better chances of success in your appeal letter.

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All of this means you need to find a way to make your letter stand out.

The best way to achieve this goal is to incorporate your branding throughout the document. This example from arthritis.org accomplishes that technique extremely well.

You see, having a professionally designed appeal letter that includes your organization’s logo and colors changes the entire dynamic of what you’re sending.

That record should not only include a copy of what you sent, but also when you sent it and when it reached the insurance payer. The last part of the previous sentence is the most important.

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Whether you send your appeal letter by mail or electronically, it is imperative that you have tracking information.

This is such an important piece of the puzzle because it gives you a timeline view of the process of trying to appeal a denied claim.

There is also the harsh reality of communicating with insurance providers. In a perfect world, as soon as an insurance provider receives an appeal letter, they respond to it and correct any mistakes that may have occurred.

Unfortunately, that is not the reality. You may need to follow up several times with providers regarding your medical denials. But if you don’t keep records and/or don’t have tracking information about what you send, it makes the tracking process much more difficult.

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Since the insurance providers are the organizations that deny the medical claims that you submit, they have no choice but to have a standardized process in place.

The form above is only the first page of the appeal form provided by Medical Mutual.

Perhaps this is the golden test. We can throw away every other test I went over earlier in this blog post right? Wrong.

You see, on a small scale, it is possible to fill out the electronic appeal letter forms found on insurance providers’ websites.

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But not all patients who come through your doors seeking help use Medical Mutual. I would bet that if ten of your patients walked through your door at once, less than half of them would use the same insurance.

In other words, you and your staff can’t keep up with all the different electronic appeal forms for every denial you get…from all the different insurance companies your patients use.

Okay, by now you’ve seen several different sample appeal letters that you can use as a basis for creating your own.

Looking at the samples provided so far will help you reduce the time it takes to resubmit your medical denials, no doubt.

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But what if I told you that there is a sample appeal letter type that can save you the most time?

Okay, I know what you’re thinking. The example above is essentially the same form as the one from the previous section. You are correct, except for the fact that this one is for UnitedHealthcare instead of Medical Mutual.

Thus, you don’t have to worry about having a template, keeping records of tracking information, and manually entering the information into the insurance organization form. Although such a solution costs money, it offsets its cost over time while making money in the long run.

By the end of this blog post, you’ve gone through a whirlwind of emotions. While it is worth looking at the various medical claim denial appeal letters out there, they are not the best option.

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To really tackle the mountain of denials your organization is dealing with, you are faced with two options.

First, you can be like the majority of healthcare and write off your denials as a loss on your books every year. Second, you can invest some money in a solution that streamlines the entire appeal letter submission process.

The second option will help you overcome your denial situation, leading to an overall increase in revenue for your organization. “This is a very important read given the current state of claims over the past 2 years and the inexperienced claims staff we sometimes encounter while processing claims. I feel that now more than ever we are getting partial declines, declines and disputes more regularly .Many of the disputes are pure misinterpretations of wording and issues of substance that we can normally resolve relatively easily with our experience as brokers.If the claim is not a simple resolution, I would follow these steps below, bearing in mind that once the claim goes to IDR there is no further negotiation we can have with the insurer or Steadfast Triage to resolve the issue. IDR should be your last step when you are sure the insurer is not willing to work with you”. – Darren Free (Claims Manager at )

If you’ve been denied an insurance claim, here are some steps you can take to appeal the decision

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We are a valuable resource for policyholders who have had their claims denied. We can provide advice and guidance on the claims process and help policyholders understand their options for challenging the denial. In some cases, the denial may be based on a factual issue, such as conflicting evidence or incomplete documentation. In these situations, brokers may be able to help policyholders gather additional evidence or documentation to support their claim. For example, the broker may recommend hiring an independent expert to provide a second opinion or a new report that contradicts the insurer’s findings. If the denial is based on an exclusion in the policy, brokers may contact technical experts, such as attorneys or insurance adjusters, for their opinion on whether the policyholder has grounds to argue the exclusion. These experts can provide a more objective and informed perspective on

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