Appeal Process For An Unexpected Medical Bill

Plans & Programs

One of the most common reasons for receiving an unexpected medical bill is that the insurer denied their policyholder’s claim. There is something that you can do in case your claim has been denied. You can appeal to it. Hence, there is still some hope if you are the unfortunate recipient of an exorbitant medical bill.

Perhaps the bill was sent to the wrong person or maybe the amount mentioned is just plain wrong. In case of such scenarios, you should stand for your rights. If this is not the case, then you should go through the terms and conditions of your health plan to see if the medical cost was covered. 

You should take note of all the benefits that the insurer has promised to provide under the health plan. Make sure that the medical service provider is in-network. The next step would be to call up your insurance carrier to find out why they rejected the claim.

If your medical service provider is in-network, then you are in luck, for such claims are the easiest to resolve. It could be that your medical service provider sent the wrong information due to which your claim was rejected. 

It’s recommended to check to see if all the information sent was correct. If there is an error, then you should alert both your medical service provider and insurer. Another possibility is a case of incorrect billing. 

For example, the CARES Act stipulates that coronavirus boosters and vaccines are to be provided for free. Medical service providers are not allowed to charge administrative fees or co-payments. If you still receive a bill from your medical service provider for getting a vaccine, then it could be due to human or system error. 

Similarly, under the Affordable Care Act, your insurer is responsible for covering preventive care as well as annual physical exams. But it could happen that your doctor carried out other tests that she deemed necessary. If your insurer thinks that this service is not included in annual physical exams or preventive care, then it could send you the medical bill.

The good news is that you can file an appeal online for the erroneous bill that was sent incorrectly to you. This might work more quickly because the system might notice incorrect or missing information, in which case, the situation can be quickly resolved. 

If your medical service provider has provided wrong or missing information, then this could lead to an out-of-network cost. To avoid this, just make sure that the information is all correct. The next time you receive a medical bill remember these tips to prevent a negative impact on your finances. 

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