Many providers view appealing denied medical claims as an unwanted, but necessary, function of back-end collections. An aggressive appeals program in your office can also be a tremendous boon to your practice’s reputation for extending exemplary customer service.
Most patients recognize that a medical provider is going above the call of duty when they attempt to overturn an unfair claim denial for the patient. To the patient, already beset with a medical malady, any assistance with dealing with complicated insurance issues is greatly appreciated. Further, a successful appeal letter written by your office which relieves the patient of a large financial burden will be something your patient is sure to discuss with friends, neighbors and mere acquaintances – all prospects for growing your clientele.
Here are some ways to reinforce this positive aspect of appealing denied claims:
Send a carbon copy of the appeal letter to the patient. Put a cc: notation at the bottom of the original so your patient will know that you are advising the carrier that the patient should be advised of all communications.
In your appeal letter, refer to your patient by name, rather than using the generic, “patient”. For example, state “Mr. Brown was treated in our office on May 5,” rather than “This patient was treated…”
When mailing the copy of the your appeal to the patient, include a brief cover letter explaining that the appeal was filed as a courtesy to the patient. Ask the patient to also appeal the denial, inviting him or her to use any information in your letter which may support the request for payment. Give them the name of your insurance representative who might be able to answer questions about medical appeals.
Advise your patient of their alternatives. You might want to keep literature in the office from your state’s Department of Insurance, Labor Department information or business cards of companies and law firms offering appeal assistance.
Finally, and most importantly, give your patient a phone call when the appeal has been successful. Many patients may be anxiously awaiting word from the carrier. If you can deliver the good news first, you will likely receive all the praise for your efforts.
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