Resources to Decrease Denied Medical Claims.
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Home | Frequently Asked Questions


Frequently Asked Questions
Membership Benefit Questions
1:  Can everyone in the office use the appeal letters if we have a membership?
2:  How will I find the appeal letter I need among the 1600+ letters?
3:  Can I buy one appeal letter for my specific denial?
4:  What is the success rate using AppealLettersOnline.com?
5:  Does this site allow me to file appeals to insurance carriers online?
6:  Are the appeal letters designed for hospitals, physicians or other specific type of healthcare providers?
 
Account/Billing Questions
1:  What is your cancellation policy?
2:  How do I know if the content is worth the membership fee until I start a membership and look at all the letters?
Content Questions
1:  Does the site content change?
2:  An insurance carrier is asking for money back that we believe was correctly paid. Do you have anything for refund/recoupment issues?
3:  We are primarily interested in challenging prior authorization denials. Can the letter be used for this purpose?
4:  Do you have specialty-specific appeal letters?
 
Other Questions
1:  Can I make changes to an appeal in the appeal letter database before I send it?
2:  How do I know if the legal information is applicable to the claim I am appealing?
3:  How can I update my Power of Appeals Software with the letters in the database?
 


Are the appeal letters designed for hospitals, physicians or other specific type of healthcare providers?
The majority of the appeal letters can be used by any type of health care provider. We have many hospital and physician subscribers as well as ancillary and alternative/complementary care providers.


Can everyone in the office use the appeal letters if we have a membership?
Yes. The terms of agreement allow the member to distribute the letters to other employees of the organization. However, only one person can be the member and access the material online. Further, distributing letters to anyone outside of the subscriberís organization is prohibited by the terms of agreement.


How will I find the appeal letter I need among the 1600+ letters?
The letters are categorized by denial type. We provide extensive information on what letters should be considered for each specific denial type and how to select the most appropriate letter.


Can I buy one appeal letter for my specific denial?
No. We do not sell letters on an individual basis.


What is the success rate using AppealLettersOnline.com?
We receive a lot of positive feedback regarding our siteís effectiveness. Further, we have a high rate of membership renewals beyond the initial year. However, we are unable to calculate an all-around accurate success rate. A memberís success rate will typically vary depending on the denials chosen for appeals, the organizationís billing policies, documentation quality and persistence in filing multiple levels of appeal. We do guarantee that the information will make it easier to file appeals since access to up-to-date information and sample letters facilitate a prompt, thorough appeal.


Does this site allow me to file appeals to insurance carriers online?
No. AppealLettersOnline is an educational resource. We do not file or process appeals for patients, medical billers or insurance carriers. Some insurance carrier have online complaint and appeal filing instructions. However, it is always a good idea to call and get the name of the appeal coordinator and send the appeal by certified mail to this person.


What is your cancellation policy?
We do not allow cancellations prior to one complete year of membership. Once a membership is started, the member is granted unlimited access to the letters and a full year of membership is required.

 
How do I know if the content is worth the membership fee until I start a membership and look at all the letters?
We have designed the web site to give visitors a very comprehensive look at the site materials. All letter titles can be viewed and a number of sample appeal letters downloaded so that potential subscribers can assess the quality of the content and determine if a membership would be advantageous.

 
Does the site content change?
We typically update the site on a monthly basis with new letters and/or existing letter updates.

 
An insurance carrier is asking for money back that we believe was correctly paid. Do you have anything for refund/recoupment issues?
Yes. We have a number of different letters to refund/recoupment responses which range from challenging untimely requests to seeking more detailed disclosure related to the reason for the action.

 
We are primarily interested in challenging prior authorization denials. Can the letter be used for this purpose?
Yes. We have a number of letters developed for prior authorization denials. Further, our medical necessity appeal letters can be very helpful if the denial is strictly clinical.

 
Do you have specialty-specific appeal letters?
Yes. We have a number of specialty-specific letters.

 
Can I make changes to an appeal in the appeal letter database before I send it?
Absolutely. Some of the sample letters may contain enough information to persaude the insurance carrier to reconsider. However, many types of denials, for example a medical necessity denial, will likely require some treatment-specific information to be effective. The appeal letters are meant to provide some various ideas on how to present information but are in no way exhaustive or complete. Users must use their judgement in deciding what information would be persausive on each appeal and include additional information accordingly.

 
Some of the letters cite legal information. How do I know if the legal information is applicable to the claim I am appealing?
One of the most important aspects of appealing denied claim is to understand the laws that apply. Many group insurance policies are governed by ERISA and are exempt from state mandates. Other payors, such as Medicare and Medicaid, fall under a different set of claim processing regulations. It is beneficial to familairize yourself with the various types of potentially applicable laws and discuss which laws apply to which payors with your attorney. The U.S. Department of Labor, State Department of Insurance and other governmental web sites also often provide some education information regarding this issue.

 
How can I update my Power of Appeals Software with the letters in the database?
Members that also own a licensed copy of our Power of Appeals Denial Management Software are able to update their POA letter database from the letters in AppealLettersOnline.com's repository. This requires that you have a licensed copy of POA v5.5 or newer. Click here for more details.