Billing errors lead to successful insurance appeals: Naughty Business of the Week

March 22, 2011|By Liz F. Kay

If your health insurance claim has been denied, here's some evidence that an appeal might be worth your time.

According to a recent U.S. Government Accountability Office report on private insurance coverage denials I discovered via Consumerist, coverage denials are often overturned in the patient's favor on appeal.

Why is that? Because frequently the denials are the result of errors, such as categorizing a service with the wrong billing code. Apparently the extra scrutiny helps shake out these careless mistakes so they can be fixed --- and sometimes that meant less money coming out of the consumers' pockets. 

In fact, the report states that claims are rarely denied because a treatment is deemed not medically necessary.

Need some details on how to appeal a denied claim? The Maryland Insurance Administration can help, if you call 800-492-6116. Check out their consumer guide to health insurance for more details about pursuing an internal review with the insurance company and escalating that further with a complaint to the insurance administration if necessary.

The state Attorney General's health education and advocacy unit, which can help mediate disputes, shares some details on its website.

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