Pathway Patient Advocates Medical Appeal

Do you have a Medical Bill?

Has your insurance company ever denied any of your claims? Have you received bills stating you’re responsible for the full cost of services rendered? Have you ever been told after receiving care, imaging, or lab work that it is not covered because the services were not necessary?

Most of us have encountered rejected medical claims. Many times, we may not know why or how a claim was rejected, but we pay anyway because we got a bill. The good news is, you do not always have to pay! After finding out why your claim was rejected, you always have a chance to appeal the rejection in hopes that the insurance company overturns their decision. This may result in them paying the claim so that you are not stuck with the bill!

Pathway Patient Advocates assists with medical bill appeals

Insurance companies only know what information they receive from the billing provider. For instance, let’s say you were having chest pain and went into an urgent care center. The urgent care does a workup including a physical exam, labs, chest x-ray, and an EKG. They end up diagnosing you with the common cold. The urgent care submits a claim to your insurance company reflecting which tests were done and what the final diagnosis was. Weeks later, you receive notice from your insurance company that you are responsible for the EKG because it was not medically necessary. Of course, this was necessary due to the chest pain you were experiencing. But to the insurance, why would you need an EKG completed is you just had a common cold? You may simply file an appeal to have the insurance company reverse the denial and pay for the services in full.  

Sounds simple, right? Sometimes it is, while others are a little more difficult. Every insurance company has a different appeal process, and it is important to understand what each company requires. Many of them are confusing and require extensive documentation. Call us today if you need help filing an appeal with your insurance company!

Pathway Patient Advocates (248) 247-8552

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