Why Insurers Deny Payment for Services and What You Can Do to Minimize Patient Responsibility

Insurers often deny coverage for medically necessary services leaving patients focusing on how to pay for healthcare and not on getting well.  This presentation provides an overview of common health insurance policy limitations and exclusions and common coverage denial reasons. While most insurance policies provide for member appeals, the member/patient is often limited to just one appeal under the policy.  It is very important to recognize the true reason why the insurer is not paying the claim and provide the best argument with any supporting information the first time the matter is appealed.  It may be the only shot at getting the service covered.

This presentation covers the following:

• How the Affordable Care Act has impacted the appeals process
• Tips for composing and filing effective appeals
• Laws, regulations and common law principles that can be utilized when laying out the argument
• Avenues for escalating issues when an insurer will not review the patient’s appeal.