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CLAIMS & BILLING

TIPS FOR REDUCING DENIED CLAIMS

As soon as you receive your initial "welcome packet" from your carrier, call all of your current providers to update your plan information.  Be sure to also go online and pull up the provider networks, search for urgent cares, specialists, labs and pharmacies so you are aware of who is in network and how your benefits work.  Knowing this information before-hand can save a lot of headaches later.  If you're experiencing an emergency, go to the nearest emergency room.

There's nothing worse then having a claim denied and getting a surprise bill in the mail because you didn't realize that you went out of network.  The absolute worst time to try to figure all of this out is when your sick or injured. GET A PRIOR AUTHORIZATION FOR ALL NON-EMERGENCY APPOINTMENTS. This just means to ask your providers office to verify your benefits BEFORE your appointment. This way, if there's a problem, you'll know about it in time to make any adjustments necessary.

WHAT TO DO WHEN YOUR CLAIM HAS BEEN DENIED OR PARTIAL-PAID

  1. First, reach out to your broker (me) so I can help you determine your best course of action and find out why the claim was denied.

  2. Read your health insurance policy and understand the terms and conditions.  This step should be done BEFORE you decide on a plan.

  3. Learn the deadlines for appealing your health insurance claim denial.

  4. Make your case by gathering all related documentation especially information that supports the necessity of the services you received. 

  5. Write a concise & timely appeal letter that includes all of your supporting documentation and be sure it's mailed & received before the appeal deadline (varies).

IF YOU'VE TAKEN ALL THE STEPS ABOVE & STILL NEED HELP CLICK ON YOUR STATE BELOW

ARIZONA - TEXAS

HOURS OF OPERATION - MON-FRI: 9:00 - 6:00 - SAT: 9:00 - 1:00 - SUN: BY APPOINTMENT

The views and opinions expressed on this website are those of the agent and do not necessarily reflect the official policy or position of any agency, carrier, US Government or any other entity or person(s).  It's always a good idea to conduct your own research before forming an opinion and before making a purchase. 
 
This website is operated by SafetyNet Insurance Group and is not the Health Insurance Marketplace℠ website.  In offering this website, SafetyNet Insurance Group is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans(QHPs) being offered in your state through the Health Insurance Marketplace℠ website. To see all available data on QHP options in your state, go to the Health Insurance Marketplace℠ website at HealthCare.gov.  Also, you should visit the Health Insurance Marketplace℠ website at HealthCare.gov if:
1.) You want to select a catastrophic health plan.
2.) You want to enroll members of your household in separate QHPs.​
3.) The plans offered here don’t offer pediatric dental coverage and you want to choose a QHP that covers pediatric dental services or a separate dental plan with pediatric coverage. Pediatric dental services are an essential health benefit.

SafetyNet Insurance Group offers the opportunity to enroll in either QHPs and off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.
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