One of the most distasteful tasks is tending to medical bills. One reason is that the medical billing system is almost deliberately complex and can leave a person exhausted. There are always multiple forms, with fine print, that require the patient or payer to act as a legal expert – when all you want to do is get the bill paid and move on.
This is the reason that medical insurance advocates have come into being. They are a spokesperson on your behalf. They are able to work through the medical billing system and understand its nuances.
The issue usually begins when payment of a bill has been denied by your insurance carrier. Once it is ‘kicked back’ to the payer they must review the cause and find an appropriate response. Often the patient is either too ill or in recuperation and unable to give a bill the proper attention. It requires undivided focus to wade through medical bills, as well as some knowledge of the system, and many people are not up to the task. Sometimes, the remitter may attempt to negotiate a settlement on a full bill and request to make payments over time.
Medical bills become a problem after claims have been denied from insurance carriers and paying off the bills becomes a game of negotiation. This is where a medical billing and insurance advocate can help negotiate and appeal medical claim denials.
There are many reasons that a medical claim may be denied initially. For instance, it is possible the insurance company does not believe the procedure was necessary (an after-the-fact finding that can frustrate even the most even-tempered individual). It may be deemed to fall under the heading of experimental or the procedure was performed in the wrong ‘setting’. Of course, there are a dozen other excuses for denying a claim.
The insured has the option of appealing a carrier’s decision. This usually requires following a series of steps that are explained in the company’s appeal process for internal and external reviews.