Top Ten Ways Health Insurance Companies Avoid Paying Claims and Top Ten Ways To Get Paid

Know the lay of the land when it comes to health insurance companies and how to get paid

TOP TEN WAYS HEALTH INSURANCE COMPANIES AVOID PAYING CLAIMS

  1. POLICY
  2. OUT OF NETWORK AND UCR
  3. NOT MEDICALLY NECESSARY
  4. ASSIGNMENT OF BENEFITS NOT HONORED.
  5. INCOMPLETE DOCUMENTATION.
  6. DOCUMENTS DO NOT SUPPORT TREATMENT
  7. ERISA PREEMPTION
  8. THREATS – FRAUD AND ABUSE AND OVERPAYMENT
  9. DUPLICATION AND BUNDLING
  10. UNTIMELY

TOP TEN WAYS TO GET PAID BY HEALTH INSURANCE COMPANIES

  1. RELY ON TREATING DOCTOR
  2. AGREEMENT AUTHORIZING CARE
  3. FIGHT QUALIFICATIONS OF REVIEWER
  4. BALANCE BILLING AND EMPLOYER
  5. BREACH OF FIDUCIARY DUTY
  6. CONFLICT OF INTEREST
  7. UCR
  8. INSURANCE OR ERISA VIOLATIONS
  9. REQUEST ALL RELEVANT DOCUMENTS
  10. BAD FAITH