Why Outsource Denied Medical Claims?
Add Legal and Insurance Experience to Your Arsenal Against Insurers
Action over acceptance is what Appeal Solutions is all about. Insurance
companies deny thousands of claims a year with what appears to be
substantial evidence to support such nonpayment. They do this knowing
that most denials are accepted without question or action. They know
many medical providers do not have the time, legal expertise and
insurance industry experience to investigate the basis, or lack thereof,
of claim denials. They know, too, that the medical provider has an
alternative payor to pursue. Appeal Solutions provides the action.
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Many such claims end up with a collection agency which lacks the legal
and insurance experience to effectively pursue medical appeals. Appeal
Solutions provides the experience.
At Appeal Solutions, we take a hard look at every denial. We demand the
proof collected by the insurance company to substantiate the denial. We
find the case and statutory laws which apply to the denial. We review
the patients' policy language for any wording which indicates the claim
is payable. We appeal your claims based on the very best combination of
these factors. We give you an alternative to immediate collection agency
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What does that mean to your business office? Revenue!
The most important reason to place with Appeal Solutions is because
of results. Appeal Solutions successfully secures full benefits of
claims previously denied. As you know, you are far more likely to
accomplish 100% reimbursement on accounts wherein the insurance benefits
are secured first. Appeal Solutions also investigates the potential for
other third-party payors, such as victims assistance, homeowners and
auto coverage, state guarantee funds and nonprofit medical assistance
funds. We have even successfully pursued interest payments from
insurance carriers who fail to release payment as mandated by applicable
timely payment statutes. The efforts on our part lessen the burden of
uncollectable accounts on your facility's financial health.
Securing the services of Appeal Solutions can be an enormous benefit to
your patients. An account involving denied insurance may be a small
matter to some hospitals. However, to the patient, already beset with a
medical malady, a denied insurance claim can be a devastating blow. It
is not uncommon to receive thank you notes from grateful patients after
successfully resolving an insurance dispute in their favor. They will
thank you, the provider, too, for securing such a valuable service.
Appeal Solutions handles accounts on a contingency basis, thereby
eliminating any risk on your part.
The healthcare reimbursement environment is ever changing. Appeal
Solutions is dedicated to keeping abreast of the many changes involving
managed care, ERISA, state legislative mandates and the multiple other
dynamic areas of quality healthcare delivery. An alliance with Appeal
Solutions gives you access to the information you need to keep your
business office running with these changes. We are committed not only to
excellent service on account placements, but to a working partnership
with the goal of smart financial practices for the benefit of the
patient, the hospital and society's good health.
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- Medical Necessity
- Timely Filing
- Preexisting Conditions
- Lack of Precertification
- Benefit Reductions
- Refund Requests
- Stalled Claims
- Specialty Care Appeal Reviews
- Workers' Comp
- Verification of Benefits Issues
- Coding Issues