Question

Josh Davidson has just called you irate about his bill. He has received his EOB that says he owes $2150 for an emergency visit for chest pain. You have also received the EOB for Mr. Davidson that has denied the claim. The insurance company states that the information provided on the claim does not provide adequate evidence that the visit was an emergency. How will you deal with this situation? What will you say to josh? How will you explain the denial and what you can do.

Answer 1

Explanation of benefit(EOB) provides a correct track of medical care and its cost. explanation of benefit also includes information about the deductible, copay, co-insurance, etc. verify the insurance carrier and apply for the appeal process. If claims denied file the internal appeals process for the claim. the law and rules make an appeal with the patient insurer and an external review from an independent third party for claims.
Say to josh resubmitting the claims can help to locate the errors. sometimes due to error in the submission when typing create a mismatch of codes and documentation or some items could have missed from the submission cause claim denial due to processing errors. Appeal process help to deal with this situation to gather information about the issues and review the benefit.