Denied claims and appeals are the most challenging aspects of the medical reimbursement process. Despite aggressive follow up on a recent claim by Practice Management staff, the insurance company continued to reject the claim each time it was resubmitted presenting a new reason for denial even though the service was pre-certified and the claim was filed within a few days of the service date.

 

The claim was given further review by management who experienced the same frustration. We presented our case to the contacts at the health plan who continued to make excuses. Numerous attempts by phone, fax and email were made to a decision maker at the health plan without response.

 

Practice Management had the pleasure of working with Ken Ryan, Vice President of Member Advocacy at the Illinois State Medical Society, to obtain payment on this denied claim. We contacted Ken and supplied details of claims, appeals, etc. Within one business day we had notification from the insurance carrier indicating payment was on its way. We would like to recognize Ken for prodding the payer to do the right thing.

 

Member Advocacy is just one of the benefits of membership in the Illinois State Medical Society. To learn more, please contact Ken Ryan at (312) 782-1654.