Appealinig a denied claim to an employer?
I had recently filed a health insurance claim that was denied by my carrier. I was told to file an appeal with my employer. Is this something I should do?
The issue is that the physician had incorrectly coded a procedure. Due to a non response from the physician (both I and the insurance company have tried contacting the doctor. The insurance company sent a letter and that is it), my carrier denied the claim.
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The insurer probably referred you back to your employer, since it needs the physician info to review your claim and in the meantime, your claim is being held up, Your employer by the way can't do anything about that. I would suggest going to the physician office, asking that the form be corrected, and then resubmit. You should not be charged for this since your crackhead doctor didn't fill it out right the first time.
Your employer has nothing to do with it. You need the physicial to rebill, with the correctly coded procedure.
Notify him, return receipt, that "xyz" procedure that he billed, he didn't perform, therefore, neither you nor the insurance company are responsible to pay for something he didn't do. Advise him if he wants payment, to rebill correctly, to you and the insurance company, within the next 30 days. You want that return receipt, so when he doesn't respond, but sues you in court, you've got your butt covered.
your employer can't help you. unless you really want to kick the bee's nest, and suggest your employer find insurance from another company for all employees. I doubt you'll get your boss on board with that! my boss doesn't care about my health claims, which I've appealed and been denied.
You should contact your benefit rep or h r department to have them assist you in this matter. If you still cannot get it resolved, contact your state insurance department and file a formal complaint.
No, you don't file "with the employer." Take it up with the doctor.