There could be multiple reasons at play as to why the claims are denied by insurance agencies. Some often common and easily dealt with while others might be a tad bit too hard to detect without the help of a certified professional at hand to assist. Here are few reasons you might encounter from time to time.
1. Mixed-up documents: Exemplifying a case where your chiropractor has submitted a claim for Chris Martyn, but you have been listed as Chris Martin at your insurance agency which guarantees the inevitable of a denial.
2. Many times a medical billing insurance agency might disagree with the medical practitioner about the treatments involved and required due to a variety of reasons, such as:
a)The requested test or treatment is really not required to be done.
b)The test is necessary, but you are unable to convince your insurance agent for that. In that case, you have to explain more about why you need that test or service to your insurance agent.
3. When your insurance agent wants you to give priority to a less expensive option, then he will probably approve the requested treatment if you go for the option that he expected you to choose, but it is not up to the mark.
4. The insurer will deny the claim if the service is rendered by that specific physician but approve if you opt a different physician for the same service. Or you can also try to convince your insurer that the opted physician is the only physician who can render this service.
5. Inadequate data entered with the claim or pre-authorization request will also lead to claim denial. Let's say you have requested subluxation of the cervical spine, but your chiropractor didn't fill any data regarding your spine.
6. You will need denial management in healthcare if you don't follow the insurance guidelines. As an illustration, let's consider that your insurance plan requires you to get pre-authorization prior to receiving a particular non-emergency treatment. But you have got that treatment without having pre-authorization from your insurance agent. In that case, your agent has all the powers to deny your claim just because you didn't follow the guidelines even if you really wanted that treatment to be done.
How to handle claim denials :
Be it a denial for the treatment you have already had or a denial in the pre-authorization request, getting a denial is always burdensome. You may assume your ineligibility of a specific treatment because of a denial during pre-authorization, but hey, think again!
A denial doesn't necessarily disqualify you to receive a specific treatment, it simply states that the insurance shall not cover it which disqualifies you to file for a claim but you can simply opt to pay for the very same from your own pocket.
All insurance plans avail the extra benefit of the 'Appeal process' in case of a denial. The process shall be summarized in the information you receive along with the denial of the claim or during pre-authorization.
However, after putting such efforts you are not able to resolve the issue by working internally the insurance plan, you may go for an alternate method i.e. external review of the claims denial. For this, you can outsource this service to a third party chiropractic billing company like Bikhamchiro.
To avoid tricky pastures and help you streamline your claim process Bikhamchiro offers you the option of outsourcing your Claim denial process. A team of certified professionals with vast experience shall take on your denial headaches and help you achieve exponential growth and success.
To know more talk to our medical billing specialists or email. You can also visit our website Bikham dot com and follow us on Google Plus, Pinterest, Facebook, Twitter YouTube and LinkedIn for latest Medical Billing and Coding blog
