Every practicing doctor has faced the unfair denial of a claim or procedure code by an insurance company. Fear of retaliation (deselection as a contracted provider) by the insurance companies often prevents doctors from protesting claim denials. In some states, statutes protect doctors from this abusive treatment by insurance companies.
If you think that an insurance company has wrongfully denied your claim(s), and you would like a free consultation, click here.
We represent doctors in all subspecialties against all insurance companies. The following is an outline of our claim protest procedure.
CLAIM PROTEST PROCEDURE
THE CLAIM PROTEST PROCEDURE IS AS FOLLOWS:
- What do we need to protest a claim?
We need a complete claim package which includes the following:
- A copy of the originally submitted HCFA claim form.
- A copy of the Explanation of Benefits for the denied claim.
- A copy of the operative report or progress note regarding the denied service.
- A complete copy of the doctor's signed contract with the insurance company. (If you don't have a copy of the contract and cannot get it from the insurance company, contact us for help.)
- What happens after the Law Office of David Mullens receives a claim package?
The law office fully researches the history of the code(s) at issue and:
- We write an initial appeal/demand letter.
- We demand payment at every level of appeal offered by the insurance company.
- If the insurance company persists in denying payment, we take the insurance company to arbitration.
- Why does this work?
- We only pursue claims that deserve to be paid.
- We research extensively and send a demand letter that details why payment must be made.
- The insurance companies know we will pursue arbitration if the claim is not paid, which is a time consuming and expensive effort for the insurance company, and which may result in a determination against their interest.
- Whom does this process help?
- Doctors who provide services to the policyholders of medical insurance companies can now be fairly compensated for the work they do.
- Insurance companies will finally be able to staunch the loss of contracted doctors due to attrition.
- Because specialists will be able to stay contracted with insurance companies based on the insurance companies' improved compensation, patients will enjoy greater access to a broader range of specialists within their insurance network.