Filing an Appeal

[Executive Benefits]

(Sigh... pulling out hair) LOL

I have a client who I have been working on a claim for the past 2 months with UHC, now we have to do an appeal. Any advise on how to do them effectivly would be appreicated. I just went independant a few months ago and am used to throwing this off to an Admin department. Now I'm the Admin department and THAT'S SCARY! LOL

 

[ABC]

1st. Why was the claim declined?

2nd. How did the provider bill the claim?

3rd. Since you are dealing with UHC. Did the client provide all requested info from UHC?


I use to have a large block of biz. with UHC and now I just have a few groups left with them. One of the reasons I moved most of my block was because of claims processing. It seemed every large claim (over $10,000) I was having to work because UHC was sending out all kinds of request to see if there was a way they could get out of paying it.

 

[Executive Benefits]

1st. Why was the claim declined?

2nd. How did the provider bill the claim?

3rd. Since you are dealing with UHC. Did the client provide all requested info from UHC?

1. They sent her a letter asking her if she had additional coverage. In english, she only speaks spanish.

2. Not Covered due to #1
3. No, because she can't speak english, she had/has no other coverage, and they are being a PAIN in my arse! LOL Thanks for your help

 

[ABC]

1. They sent her a letter asking her if she had additional coverage. In english, she only speaks spanish.

2. Not Covered due to #1
3. No, because she can't speak english, she had/has no other coverage, and they are being a PAIN in my arse! LOL Thanks for your help

This sounds about right for UHC.
Complete the letter
Submit it for her
Record the reference number. Ask them to expedite.
Have your client contact the health provider and let them know your working the claim.
Call UHC everyday until they have resolved this BS issue.

When I had good size block with UHC I would work 5-6 claims like this month.

 

[NewHealthStrategies]

Call the DOI and get them involved.

 

[ABC]

Call the DOI and get them involved.

I would only do this at last resort.

Now you can tell the claims department that your client wants to take this step and that might speed things up even more.

Going to the DOI is always my last resort.

 

[Executive Benefits]

Thanks Guys for all of your help, I will be sending the letter out today.