If you do not agree with charges or statements from Insurance company (likely referring to Insurance company Health or its affiliates), you can appeal or dispute them. Here’s a step-by-step guide to doing so:
1. Review the Statement Carefully
- Check the details of the charges, including dates, services, and amounts.
- Compare the statement with your Explanation of Benefits (EOB) from your insurance company to identify discrepancies.
- Ensure you understand the services billed and confirm whether you received them.
2. Contact insurance company’s Billing Department
- Call the billing department (the number is usually listed on the statement).
- Politely explain your concerns and ask for clarification or an itemized bill for more details about the charges.
3. Check Your Insurance Coverage
- If you believe your insurance should have covered some charges, contact your insurance company to verify:
- Whether the service was covered under your plan.
- Why the service was denied or only partially covered.
4. File an Appeal with insurance company
If the issue isn’t resolved after contacting billing:
- Request a Formal Review: Insurance company Health typically has a process to dispute charges. Ask for a dispute form or instructions.
- Submit Supporting Documents: Include:
- A copy of your statement.
- Correspondence with Insurance company or your insurer.
- Your EOB.
- Any evidence (e.g., proof of prior authorization or payment).
5. Escalate Through Insurance (if applicable)
- Internal Appeal: File an appeal with your insurance company if the charge stems from denied or insufficient coverage.
- External Review: If your internal appeal is denied, most states allow you to request an external review by an independent third party.
6. Seek Assistance
- Patient Advocacy: Contact Sanford’s patient advocacy office or a similar department if available. Advocates may help mediate disputes.
- State Insurance Department: If you feel the charges or the insurance company’s denial is unfair, file a complaint with your state’s Department of Insurance.
- Medical Billing Advocate: Hire a professional advocate to negotiate or dispute charges on your behalf if the amount in question is substantial.
7. Legal Action (if necessary)
If all else fails and you believe the charges are fraudulent or improper:
- Consult a healthcare attorney.
- Consider small claims court if the amount in question warrants it.
Tips for a Successful Appeal
- Keep detailed records of all interactions, including dates, names, and what was discussed.
- Stay polite but persistent in your communication.
- Set deadlines for follow-ups to ensure your case is reviewed promptly.
By taking these steps, you can work toward resolving your disagreement with Insurance company over the charges in question.