Health Insurance Claim Articles

Medical Providers And Billing Agencies: There Are Things That Should Be Done Before Sending The Patient To Collections Or Writing Off The Medical Bill

This follows up on the Merlin Law Group’s attendance at an April 2015 conference put on by the Healthcare Billing and Management Association (HBMA). As I discussed with several folks at the HBMA conference kind enough to stop by the Merlin Law Group’s exhibitor hall booth, medical providers and / or billing agencies should consider looking into the contractual, legal, and / or factual (im)propriety of the health insurance company’s claim denial or partial payment before sending patients into collections or writing off the medical bill.

It should not come as a surprise that sometimes an insurance company’s claim denial does not find support in the insurance contract, in the law, and / or in the facts. It is my humble suggestion, therefore, that medical providers and / or billing agencies consider the (im)propriety of the carrier’s claim decision before putting any next steps into action. The Merlin Law Group will happily perform, as a courtesy, an intake analysis aimed at determining the (im)propriety of the carrier’s claim decision and discuss possible next steps with the potential client. And the “next step” does not always have to be litigation. Oftentimes, an insurance company’s improper claim denial can be unwound with legal letter writing shy of litigation. Sometimes, in some states, there are statutory pre-suit tools available to try to unwind an improper claim denial without litigation (e.g., a Civil Remedy Notice in the State of Florida). Sometimes, there is a contractually prescribed appeal process available to unwind improper claim denials, and, if approached thoroughly and thoughtfully, this process can actually work.

So, moral of the story? Examine the insurance company’s actions before you take negative action with respect to the patient (e.g., collections) or the medical provider (e.g., writing off the medical bill).

Health Insurance Claim Articles