What to do if my insurance company denies a hospital claim

If your insurance company denies a hospital claim, the first step is to contact your insurance company and ask for clarification. Your next step will depend upon their reason for denial. They should address any fees that you are responsible to pay related to copays and deductibles. Beyond these fees, perhaps the denial requires the hospital to respond: this could involve their correcting a claim that was initially billed in error, or it could involve their appealing the denial. Whatever the reason, you should follow up with a call to the hospital to see if they plan to respond to the denial in any way. During this conversation, the hospital should inform you if there are any other issues that might require your assistance to resolve.

What to do if a hospital bills me directly

If you receive a bill from the hospital, it usually signals that the hospital has done everything it can to resolve the issues that stand in the way of payment, and they have no recourse but to bill you directly. If you don’t believe you should be responsible for the balance billed to you, or if the resolution is not straight-forward, you need to begin a thorough forensic review and accounting of the charges and the processing of those claims.

How to lower a hospital bill and get a discount
First, request a detailed bill from the hospital, one that includes each charge listed by line item, code, billed fee, allowed fee, balances and the reasons for the balances. In order to properly determine if the coding is correct, you need to request all of your medical records. It is at this point that you might need to enlist the services of a medical claims advocate, someone with experience translating documented notes into appropriate procedure codes. Since each procedure code is associated with a specific fee, if the incorrect codes were billed, your bill could reflect services that you never received.

Hospital bills are often extensive, confusing, and time-consuming. Getting to the bottom of the bill could require the help of experts. If this is a situation in which you find yourself, you don’t have to go it alone. Reach out to us for further clarification and assistance.



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