“Don’t take no for a final answer when a health insurer rejects a claim and leaves behind an unpaid medical bill. As many as 50 percent of some appeals prompt insurers to reverse their decisions, according to a report from the Government Accountability Office.”
That was the opening of a recent article in the Washington Post. The gist of the story is that about half of all health insurance claim denials are reversed on appeal. So if your insurance company refuses to pay a claim, don’t simply accept that as the final answer, take steps to appeal the denial, and you may save yourself hundreds or even thousands of dollars. Here are additional excerpts from the article:
Insurers frequently deny claims due to billing errors, missing information or judgments on whether the care or service is appropriate, the investigative arm of Congress said in a report released Wednesday.
These denials can be based on mistakes like an incorrect code on a claim submitted by a doctor’s office, said Nancy Davenport-Ennis, CEO of Patient Advocate Foundation, a not-for-profit that helps people appeal claims denials.
“You’ve got a lot of people in America who are ultimately paying a bill they don’t owe because they don’t realize it’s an incorrect code,” said Davenport-Ennis, who wasn’t involved in the government study.
The GAO studied health insurer rejection rates at the request of Congress, which wanted a better picture of the issue as part of the health care overhaul it passed last year. The overhaul aims to cover millions of uninsured people after it unfolds over the next few years.
These figures do not mean patients have nearly a 50 percent shot at success if they appeal a denial. The statistics are based on cases appealed, and only a small portion of denials are challenged, said John Dicken, a GAO health care director.
“There are many times the claim is denied the first go-round to see if you come back and appeal,” Davenport-Ennis said.