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.

5 Tips to Increase Your Car Accident Settlement Negotiation

Accident reportA car accident, even a minor incident, can turn into a pile of medical bills, auto repair appointments and expenses, and car rental costs.  To increase the chance of recouping funds to pay for all those expenses, you need to take a few essential steps—starting just a few minutes after the car accident.

Call the police.

Even if your accident seems like nothing more than a minor fender bender, contact the police after your accident.  There could be more damage to your vehicle than is visible to the eye, or you may need more medical attention that you first anticipate.  A police report is vital to your claim as you pursue compensation for damage and injuries.

Collect information at the scene of the accident.

If possible—and this is not always possible if you need medical transport—get information from the other driver and any witnesses at the scene.  If you call the police, they can often capture this information in the police report.  Take pictures with your cell phone to document the accident scene, damage, and injuries.

Seek medical attention ASAP if needed.

If you are hurt, don’t wait to make a doctor’s appointment, or, if your injuries are more serious, to go to the hospital for treatment.  Getting medical attention as soon after the car accident gives you the documentation you need to establish that your injury or injuries was caused by the accident.

Keep all documentation.

Don’t throw anything away after your car accident.  Keep a file or folder with the police report, medical documents, car rental receipts, paperwork pertaining to the damage to your car, and any other documentation you receive after the car accident.  Proper documentation can be essential during negotiations and conversations with the insurance company.

Contact a good car accident lawyer.

A good car accident lawyer can be an excellent advantage in your negotiations with the insurance company, and in your recovery.  Contact a good accident lawyer if: 1) the cost of your damages and injuries is significant 2) you need restitution for future costs or losses 3) there is some dispute over fault in the accident.  A lawyer can take over all contacts with the insurance company and negotiate for the full cost of damages and injuries.

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.

5 Steps for Getting Your Security Deposit Back

dollar pile of security deposit backIt would be so easy to just pay a security deposit, and then receive it back when you move out. However, there are circumstances and regulations that may inhibit that simple process—but there are steps you can take to make the return of your security deposit smoother and easier.

Think ahead.

Thinking ahead before you move out can save you a load of hassles later—and get your full security deposit returned. If you have a fixed-term lease, such as a 12-month lease, and you have to move out, find another tenant to take over your lease. For a month-to-month lease, give the appropriate amount of notice (i.e. 30 days, 15 days, etc.) as specified in the lease you signed. If you don’t give proper notice, your landlord may be allowed to deduct the amount of unpaid rent from your security deposit.

When you give notice, inquire about the expectations of your landlord. What condition do they expect your rental to be in after you move it? When you get an answer, make an effort to thoroughly clean your rental and leave it in the condition described by your landlord. Take pictures of the rental after you move out to ensure you have documentation in case of any future conflict.

Be patient.

By law, your landlord does not need to return your security deposit immediately when you move out. Be patient and wait for the deposit, which is typically (dependent upon local regulations) within 21 days. Usually you receive the deposit (or what remains of the deposit) in the mail with a statement detailing any deductions taken from the security deposit.

Contact the landlord.

If you disagree with the amount of security deposit that is returned, (calmly) contact your landlord. State the reason you disagree with any deductions, and discuss steps needed for resolution. Document the date and time of your call (or calls) and discussions for future reference, if needed.

Get legal advice.

If these steps have not resolved your issue, contact an experienced, local real estate lawyer. The lawyer can outline your options to get your security deposit back, such as pursuing the matter in small claims court, or can assist you with further actions, such as drafting a strong letter to your landlord, which may resolve your problem.

Consider small claims court.

You may be able to get your security deposit back in small claims court. There is a small cost to the process, so make sure the amount of your security deposit is worth your time and effort. You don’t need a lawyer to represent you in small claims court, but contacting a lawyer can increase your chance of success.

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.

Top 5 Mistakes a Landlord Should Avoid

piggy bank surrounded by stacks of dollar bills from a rental propertyOwning an income property, and consistently generating income from that rental property, can feel like an art—the art of always trying to minimize mistakes that interrupt your bottom line.  In addition to common home repair mistakes, a landlord also has to minimize costly legal mistakes that could cost far more than a leaky pipe or dead furnace.

Not vetting a potential tenant before renting to them

Ignoring this important step can lead to headaches later: missed rental payments, excessive damage to the home, broken rental agreements.  You’d be foolish not to vet your prospective tenants, but it’s essential that you know what you can do—and not do—during the vetting process and what questions you can ask applicants.  Improper execution of either process can lead to legal repercussions from denied applicants.

Not having a signed rental agreement

Don’t be in such a rush to rent that you neglect to have your tenants sign the rental agreement, or that you pass over the opportunity to review the terms of the rental agreement with them.  You should also provide your tenant with a copy of the signed agreement, and document that you provided the tenant with the agreement.

Using a generic rental agreement

Using a generic one-size-fits-all rental agreement that you download off the internet, or get from another landlord, can leave you open to problems because of the different laws specific to each state.  Contact a local attorney to make sure your rental agreement that is updated and specific to your state, protects your rights and the tenant’s rights, doesn’t include prohibited terms, and doesn’t place any additional and unnecessary obligations on your shoulders.

Failing to document the condition of the premises

This important step has to happen at two different points in the rental process: when the tenant begins tenancy and when they move out (or end tenancy).  Don’t ever underestimate the value of documenting as a landlord; if any problems turn into a legal proceeding, the landlord needs to have the original documentation.

Making illegal assumptions

Don’t assume that your actions are legal without contacting an attorney.  Even actions that seem common-sense can lead to legal issues.  Simply put, a few minutes of your time now can save you from the cost, time, and effort of landlord legal hassles later.

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.

Real Estate Closing Procedures: What They Mean for the Home Buyer

Finding a new home is just the start of your legal journey to home ownership.  The next step is drafting an offer to purchase, which can be done by an attorney or real estate agent.  Because of recent changes to government regulations to the real estate closing procedures, the last step of the transaction, closing, has seen some significant changes for lending agencies and home buyers.  Here’s what you, the home buyer, needs to know as you navigate through your real estate closing.Loan Estimate form
Forms
Three forms have disappeared from the closing table: the HUD-1, Good Faith Estimate, and Truth in Lending Act Disclosure.  In their place, the buyer should expect to see two nicknamed ‘Know Before You Owe’ forms: Loan Estimate and Closing Disclosure form.  The Loan Estimate form includes the loan type, terms of the loan, interest rate, estimated tax, insurance, and assessment figures, as well as other costs that affect the final cost to the property owner.  The Closing Disclosure has fields that detail closing costs, fees charged to the buyer and seller, and other figures that help all parties understand how much they need to bring to closing and loan-related costs.

Time period
One of the major real estate closing changes involves the time period the buyer receives documentation before closing.  Prior to October, closing documents were presented to the home buyer and seller usually on the day of closing. Under the new regulations, borrowers must receive documents three days prior to the closing date.  Once the buyer has completely reviewed and approved the documents, a borrower must indicate via email, phone call, or signature on a printed form that they have intend to proceed.

Closing Day
On closing day, the home buyer should bring all necessary documentation to the meeting such as (but not limited to) proof of homeowner’s insurance, Loan Estimate, and the Closing Disclosure form.  The home buyer also needs to bring any payments they want to pay for out of pocket such as closing costs, down payment, fees, etc.

If you have any questions about the closing process, or to draft an offer to purchase on your new home or rental property, contact an attorney. An attorney ensures compliance with the terms of the offer, reviews lending documents and title insurance, addresses title concerns, reviews closing documents, and overall makes sure the transaction proceeds as smoothly as possible.
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.

Firm Donates to Local Charities

December_2015_Stocking_Exchange_Gifts_340_192Neuberger, Griggs, Sweet & Smith, LLP is happy to continue its community involvement with donations to the Watertown Human Society and Mary’s Room this holiday season. Donations included cash and items, including dog food and treats, toys and diapers.

Both organizations support wonderful causes. The Watertown Humane Society provides for the lost, homeless, neglected and abused animals of the City of Watertown and surrounding communities and educates and enlightens the public regarding animal welfare. Mary’s Room is a collaborative effort of the Watertown community businesses, churches, and other charitable organizations that provides items such as diapers and wipes to women and children in the 0-3 age range.

Neuberger, Griggs, Sweet & Smith, LLP has served clients from our offices in Watertown and Lake Mills since 1922. Our firm regularly serves clients located in Dodge County, Jefferson County, Dane County, Columbia County, Washington County, and Waukesha County, the communities of the Watertown, Lake Mills, Waterloo, Johnson Creek, Reeseville, Ixonia, Oconomowoc, Sullivan, Jefferson, Cambridge, Columbus, Deerfield, Marshall, Juneau, Fort Atkinson, Beaver Dam, Hartford, Madison, Sun Prairie, Monona Grove, Cottage Grove, McFarland, Stoughton, Edgerton, Delafield, Pewaukee, Dousman, Hartland, Brookfield, and Waukesha, and all of Wisconsin.

Mark S. Sweet Announces Candidacy for Judge

Attorney Mark S. Sweet has announced that he will seek the Municipal Judge position for the City of Watertown in the 2015 spring election. Attorney Sweet would succeed Municipal Judge Ron Ziwisky, who announced earlier this year he would be retiring at the end of his term. Attorney Sweet is the first person to announce his candidacy for the upcoming election.

Attorney Sweet has been a partner with Neuberger, Griggs, Sweet & Smith, LLP since 1993, having originally joined the firm in 1991. Attorney Sweet looks to continue the firm’s tradition of judicial service. Previously, George E. Niemann, Arnold K. Schumann, John M. Ullsvik, and William H. Woodard, all affiliated with the firm during its history, have served as Circuit Court Judges.

Attorney Sweet will remain an active attorney and continue to practice with the firm if elected as Municipal Judge. Attorney Sweet practices in a range of areas, with particular expertise in the representation of individuals injured in accidents. He is admitted to practice law in California and Wisconsin. Attorney Sweet is a member of both the California Bar Association and Wisconsin Bar Association, a sustaining member of the Wisconsin Academy of Trial Lawyers, and holds membership in the American Trial Lawyers Association, American Bar Association, Dodge County Bar Association, and Jefferson County Bar Association. He is also a member of the Board of Directors of the Wisconsin Academy of Trial Lawyers.

Neuberger, Griggs, Sweet & Smith, LLP has served clients from our offices in Watertown and Lake Mills since 1922. Our firm regularly serves clients located in Dodge County, Jefferson County, Dane County, Columbia County, Washington County, and Waukesha County, the communities of the Watertown, Lake Mills, Waterloo, Johnson Creek, Reeseville, Ixonia, Oconomowoc, Sullivan, Jefferson, Cambridge, Columbus, Deerfield, Marshall, Juneau, Fort Atkinson, Beaver Dam, Hartford, Madison, Sun Prairie, Monona Grove, Cottage Grove, McFarland, Stoughton, Edgerton, Delafield, Pewaukee, Dousman, Hartland, Brookfield, and Waukesha, and all of Wisconsin.

Importance of Advance Directives

Often when people think of estate planning they are focused on the disposition of their assets and minimizing tax implication. However, advance directives are a very important component of any estate plan and they are relevant for every person regardless of their wealth. Advance directives are legal instructions that express your wishes regarding your financial and health care decisions. If an individual has not previously executed advance directives and can no longer make decisions for themselves due to an accident, illness, or mental affliction, legal proceedings in court to appoint a guardian for the individual will likely be necessary. An individual’s family members are not automatically authorized to make decisions for incapacitated family members because Wisconsin is not a “next of kin” or “family consent” state. Guardianship proceedings are exceedingly more lengthy, costly, stressful and public then advance directives.

In Wisconsin there are four different advance directives authorized by statute. The first is the Power of Attorney for Finance and Property. This document grants authority to another person, known as an “agent,” to make legal and financial decisions on your behalf. The powers granted can be broad or limited in scope. Your agent can assist you with your personal finances, insurance policies, government benefits, estate plan, taxes, bank accounts, retirement plans, business interests and essentially any other financial matter.

The second and third advance directives in Wisconsin are the Power of Attorney for Health Care and Declaration to Physicians (a/k/a Living Will). These documents both deal with health care decisions, although the Declaration to Physicians is much more limited in scope. A Power of Attorney for Health Care allows you to appoint an agent to make any health care decisions on your behalf in the event of incapacity. A Declaration to Physicians allows you to only state your preferences regarding receiving or withholding life-sustaining medical treatment if you have a terminal condition or are in a persistent vegetative state.

The final advance directive available in Wisconsin is the Authorization for Final Disposition. The Authorization for Final Disposition allows an individual, known as the “declarant,” to designate and individual to make funeral arrangements upon the declarant’s death. Further, it also allows the declarant to detail their preferences and desires regarding their final disposition and funeral service.

As indicated, advance directives are relatively inexpensive and easy to implement, especially in comparison to the procedure necessary if an individual does not have such documents in place. As with all estate planning issues, it is important to discuss the impact of advance directives with a knowledgeable attorney.

Neuberger, Griggs, Sweet & Smith, LLP has served clients from our offices in Watertown and Lake Mills since 1922. Our firm regularly serves clients located in Dodge County, Jefferson County, Dane County, Columbia County, Washington County, and Waukesha County, the communities of the Watertown, Lake Mills, Waterloo, Johnson Creek, Reeseville, Ixonia, Oconomowoc, Sullivan, Jefferson, Cambridge, Columbus, Deerfield, Marshall, Juneau, Fort Atkinson, Beaver Dam, Hartford, Madison, Sun Prairie, Monona Grove, Cottage Grove, McFarland, Stoughton, Edgerton, Delafield, Pewaukee, Dousman, Hartland, Brookfield, and Waukesha, and all of Wisconsin.

Former Partner John A. Neupert Passes Away

John A. Neupert, former partner with Neuberger, Griggs, Sweet & Smith, LLP, passed away on February 15, 2015.

Atty. Neupert received his high school diploma from Lake Mills High School in 1950, his bachelor’s degree from the University of Wisconsin-Madison in 1955, and his juris doctor from the University of Wisconsin Law School in 1962. From 1964 to 1968, he served as District Attorney for Jefferson County. Afterwards he began practicing law in Lake Mills with Robert Ferry and, in 1974, began practicing with Thomas O. Wakeman. Their firm ultimately merged with another to create what is today known as Neuberger, Griggs, Sweet & Smith, LLP. Atty. Neupert retired from the practice of law in 1997, but remained active in the day to day operation of the Bank of Lake Mills, where he served as a member of the Board of Directors since 1967 and president since 1970.

During his extraordinary life, Atty. Neupert also served as a member of the Board of Directors and as president of L.D. Fargo Library for almost 50 years. He was on the Civil Service Commission, the Highway Safety Committee, and served on the Board of the Lake Mills Emergency Medical Service. In addition, Atty. Neupert was on the Board for the Jefferson County Humane Society, was past president and member of the Lake Mills Rotary, and was Board Director for 11 years for Fort Memorial Hospital. Finally, Atty. Neupert retired as a Captain after 22 years combined in the U.S. Navy and Naval Reserves.

The attorneys and staff of Neuberger, Griggs, Sweet & Smith, LLP wish to express their deepest condolences to Atty. Neupert’s entire family. Memorial services will be held at 3:00 p.m. on Saturday, February 21, 2015 at United Methodist Church in Lake Mills.

Neuberger, Griggs, Sweet & Smith, LLP has served clients from our offices in Watertown and Lake Mills since 1922. Our firm regularly serves clients located in Dodge County, Jefferson County, Dane County, Columbia County, Washington County, and Waukesha County, the communities of the Watertown, Lake Mills, Waterloo, Johnson Creek, Reeseville, Ixonia, Oconomowoc, Sullivan, Jefferson, Cambridge, Columbus, Deerfield, Marshall, Juneau, Fort Atkinson, Beaver Dam, Hartford, Madison, Sun Prairie, Monona Grove, Cottage Grove, McFarland, Stoughton, Edgerton, Delafield, Pewaukee, Dousman, Hartland, Brookfield, and Waukesha, and all of Wisconsin.