Why Outsource Denied Medical Claims?

Add Legal and Insurance Experience to Your Arsenal Against Insurers

Action over acceptance

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.

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 placement.

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.

Patient Relations

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.

No Risk

Appeal Solutions handles accounts on a contingency basis, thereby eliminating any risk on your part.

Empowerment

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.


AppealLettersOnline.com can assist providers implement an effective denial management program.

AppealLettersOnline.com is an interactive resource provided to level the playing field between Insurance Companies and Medical Providers. You will find appeal letters, case studies, articles, other resources and the latest intelligence necessary to help healthcare providers make vital decisions and take strategic actions to address payer denial issues. AppealLettersOnline.com will help health care providers actively develop the processes, analytical tracking information, educational programs and procedures needed for implementing an effective denial management program.

Some of the topics covered at AppealLettersOnline.com include addressing payment reductions such as usual and customary and out-of-network care reductions, lack of timely filing denials, pre-existing conditions and medical necessity appeals and improving verification of benefits procedures. Treatment exclusions, maximum benefits denials and subrogation/coordination denials are also discussed. Tips are also provided on appealing for interest and penalty payment on late payments and appealing a request for a refund of previously paid claims. AppealLettersOnline.com discusses all types of claims including Managed Care, Indemnity, Government, Self-Funded, ERISA claim issues and managed care contractual payment discrepancies.