Don’t Be Denied

In Part 2 of the top reasons for an insurance plan to deny a medical claim, we review prior authorization, fundamental rules on prescription drugs, medical necessity, out-of network providers, emergency exceptions, service types, and bundling of codes.

There are many reasons for an insurance plan to deny a medical claim. In part 1, we cover coding, how to discover what’s covered, how to read your Explanation of Benefits, timing issues and what happens with Coordination of Benefits.

In this episode, we discuss a particular medical appeal process we were involved in for a client. While discussing the particulars of the denial, we go over the dos and don'ts, what information to include in an appeal letter, with whom you can partner in gathering "evidence," and more.

An introduction and overview to our important series, “Don’t Be Denied.”  We cover “the basics” on medical insurance claim denials and the reasons behind them, introducing the concepts of appeal and the many methods that need to be followed in their pursuit.

Welcome to Don't Be Denied, a conversation series dedicated to help you more fully understand how your health insurance works or doesn't work. My name is Dr. Alan Feren, and my co-host is Jordan Shields. Together we have decades of experience in helping people navigate the often troubled waters of healthcare.