Why Appeal?

When your practice increases its appeals for wrongfully underpaid or denied claims, the health plan may correct its claims editing software and processes. This, in turn, may result in improved claims processes and appropriate payment to your practice for the provision of health care services.

 What is lost when your practice does not appeal?

When your practice does not audit and appeal inappropriately paid or denied health plan claims, you may lose revenue.

You also may lose the opportunity to recover overhead expenses by not implementing a claims management process. This process is your practice’s internal designated workflow for accurately preparing, submitting and collecting on claims. When you challenge inappropriate claim payments, you demonstrate that your practice has made an effort to correct the plan’s inaccuracy. This could lead to a positive change in the health plan’s business practices.

Appealing claims that are inappropriately denied by health plans can make a difference in your practice by reducing future denials.

		We are going to APPEAL every charge that we can until it is paid in full. Because we have a reputation with the insurance companies for doing this so consistently, they will start to pay your claims upon first filing.
		We will track your allowables. We give our employees, posting payments, your contracted rates with all of the insurance companies that you are in network. We have them verify that the payment is the same amount as your negotiated rate. If not, #3 is our next step.
		We will file complaints with the State Department of Insurance.   When the insurance companies don't pay you at your negotiated rates, we immediately turn them to the State Department of Insurance for breach of contract. We demand to be paid 100% of BILLED charges (not allowable) with 18% penalty fees. We do this every time and the insurance companies start paying you correctly.   For any out of network procedures you perform, we will appeal 3 times or until we are paid in full. If they haven't paid correctly by the third time, we turn them to the State Department of Insurance and, again, demand 100% of BILLED charges and 18% interest and fees.