Incorrect Payments & Deductions

Insurance carriers now exercise great control over both in- and out-of-network payment through implementing fee schedules, usual, customary, and reasonable (UCR) limitations, and, more insidiously, computerized payment methodologies for applying internal bundling, downcoding, and other price control features. Often, it is difficult to even determine how a medical claim was paid and whether these payment policies are applied consistently and fairly across all similar claims. Read more about how to appeal incorrect benefit calculations.