Managing an Insurance Denial

August 13, 2012

There are times when a patient who believes they are covered by their insurance policy, in fact receives a denial. The first reaction is usually one of panic, but it need not be. Every insurance company has a process by which denials can be appealed. Denials are common occurrences today. With the sheer number of claims filed every day, there are often mistakes and oversights. There are, of course, times where the denial is legitimate too. The key to managing a denial is to understand the reasons behind it.

  • The first and most important course of action is to contact the insurance company and find out why, exactly, they denied the claim. Make sure that you receive this denial in writing. If the claim was denied because of missing information or a clerical error, the fix should be relatively easy. You may wish to contact the billing specialists at your bariatric surgery office as well as your primary physician. They will review your denial and offer guidance.
  • For more complex issues and legitimate reasons regarding the denial, this is the time to call the billing specialist at your surgeon’s office. The office will be able to work with you to submit a revised claim and address the problems from the insurance company’s perspective.

The insurance process is a challenge and denials are never the outcome we’re looking for. We have to remember that insurance companies are usually large organizations that make mistakes and are trying to ensure that each and every claim is valid. Bearing that in mind, we can address the denial calmly and precisely to get it overturned.  Remember that you are not alone in this process, so relax and use the resources around you to their fullest extent.

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Advanced Surgical Associates is one of the first exclusively surgical groups practicing in Union County New Jersey. And that is just the first of many firsts for ASA. For over 40 years, we have pioneered breakthrough surgical patient care in North Jersey in both general and weight loss surgery. ASA also offers gastric bypass, gastric sleeve and gastric banding to those suffering from obesity in New Jersey.
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