5 Tips for a Successful Medical Claim Appeal

Health Insurance Denied Form Showing Unsuccessful Medical ClaimIt can feel like you’ve been thrown a real curve ball when your medical claim is denied, and like you’re about to climb a major mountain.  The good news is that the “climb” is usually worth it; the majority of medical claim appeals are resolved, making appealing your claim a worthwhile effort.

Understand your Explanation of Benefits.

For every appointment or service you receive, you should receive an Explanation of Benefits (EOB).  Your EOB should include the date of service,  service(s) provided, how much your insurance covers, how much you owe, any reasons for denial (if applicable), and any other pertinent information.  If your claim was denied, the EOB should list the reason for denial usually with a code.  If you don’t understand the reason, contact your insurance company for an explanation.

Start with a phone call.

There may be an easy resolution to your claim denial.  Start by calling your medical insurance company.  Ask about the reason for the denial, the process to resolve the issues and a possible appeal (not all denials require an appeal for a successful resolution).  Sometimes a medical claim denial can occur because of an error in coding, incorrect patient information (i.e. wrong insurance ID number, etc.), or simply sending the claim to the wrong company.  An example of this would be if your eye appointment was sent to your health insurance in lieu of your vision insurance.

Stay calm.

Take a deep breath before you call insurance and doctor’s office.  The representative on the phone is not the enemy, BUT don’t be afraid to ask for a supervisor that can give you more information.  Be calm.  Prepare a list of questions you need answered so you can get all the information you need during the phone call.  Be prepared to call your doctor’s office next for supporting documentation.

Develop a system.

Now is the time to keep careful notes and be organized.  Note all representatives you talk to, date and time of the call, paperwork needed, deadlines, and dates when paperwork was sent in (either by you or the doctor’s office).  Keep a file with all relevant documents and records.  When you do have to submit documentation, double check your letters and documents to make sure that all required information is included.  Don’t be afraid to go above and beyond the minimum requirements to ensure a smooth appeal process.

Don’t be afraid to ask for help.

There are numerous resources that can help you as you navigate through the appeal process.  Some companies even offer advocacy services to assist.  Find out if your company is one of them.  For a major claim denial, consult with an attorney experienced in claim denial.  An attorney can assist you in navigating through the system and increase your chance of a successful appeal.

The materials on this website are provided for informational purposes only and do not constitute legal advice. These materials are intended, but not promised or guaranteed to be current, complete, or up-to-date and should in no way be taken as an indication of future results. Transmission of the information is not intended to create, and the receipt does not constitute, an attorney-client relationship between sender and receiver. You should not act or rely on any information contained in this website without first seeking the advice of an attorney.

4 Tips for Smooth Business Succession Planning

office workers hands on top of each other all invested in business succession planningBusiness succession planning is an integral—and sometimes “sticky”—part of business simply because of the personalities and family dynamics that come into play during the process.  While family dynamics may complicate the process, don’t let the inevitable personality clashes hold or delay your transition and planning; this course of action is an important part of business when a family member or partner is ready to retire or take a lesser role within your business.

Recognize the importance of the process.

Business succession planning is about more than appointing the successor or successors of your business.  A solid business succession plan ensures 1) the transition of parties is set and legally sound; 2) financial details are handled to ensure the succession of partners can occur (without fear of an external takeover); 3) to ease the process should any partners pass away while in business; 4) an owner can exit the business, or take a lesser role, while having their financial investment recognized.  While it’s easy to dismiss the process as a matter “for another day,” initiating and following through with a business succession plan is an essential part of running a business.

Don’t wait to start your business succession planning.

No one can predict the future; this is especially true in business.  Start your business succession planning by discussing the future of your business with all parties that are affected by the transition—including parties that are not interested in carrying on the business.  This could include all children of the owner, partner spouses, top company managers, and any other loyal employees INVESTED in the company.  Once successors have been identified, and all parties vested in the transaction are comfortable with their future partnership, it’s time to initiate the process.

Be clear about expectations.

Both on the financial and human resources side of your business succession planning, be clear about the expectations during the transition—both for the owner and successors.  Communicate clearly and openly with all parties.  Set a clear time frame and communicate with all parties expectations during this period.

Consult an attorney.

To ensure that all legal and financial aspects of your business succession planning are anticipated and documented, consult an experienced attorney.  Every business succession plan is unique; there is no “one size fits all” plan because the organization, finances, and parties involved are different.  An attorney can customize your plan to fit where your business is at now, and where you want it to be in the future.

The materials on this website are provided for informational purposes only and do not constitute legal advice. These materials are intended, but not promised or guaranteed to be current, complete, or up-to-date and should in no way be taken as an indication of future results. Transmission of the information is not intended to create, and the receipt does not constitute, an attorney-client relationship between sender and receiver. You should not act or rely on any information contained in this website without first seeking the advice of an attorney.