Page 2 - Avoiding Suprise Medical Bills
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©2016 Health Advocate HA-M-1510041-1FLY
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Four Key Steps Questions about a denied claim?
Stay “in-network.” Most denials occur Your Personal Health Advocate can help you sort it out
because patients use providers who are out of to get the bill reprocessed for payment. We can….
their plan’s network for their care. Before you
even make an appointment, always confirm • Look for duplic ate billing. For example, a medication may have been
that your providers, hospitals and other billed when it was prescribed and then again when it was administered.
medical facilities are “in-network.” • Check for incorr ect coding. The treatment or procedure code may
Get appropriate pre-approvals prior to not match the diagnosis code.
receiving services. Check to see if your plan • Address lac k of preauthorization. If your doctor ordered an MRI,
requires a pre-certification, pre-authorization for example, we can work with him or her to obtain the proper
or referral for services to cover them. authorization to get the claim paid.
Double check that your information is • Obtain proper documentation. Some bills are denied because the
complete. Make sure your personal informa- insurance deemed them not medically necessary. We can work with
tion including your name and health insurance the doctor to get any required paperwork that may be needed.
number is correct on the paperwork.
• Review for data entry err ors. We’ll check that your current health
Understand frequency limitations. Benefits policy was entered correctly and look for typos.
for certain services such as mental health
counseling, may have limitations for the Remember… your Personal Health Advocate can help you understand
number of visits that will be covered by your your coverage, obtain pre-approvals, handle denied claims and assist with
insurance company. Check to find out if you a variety of healthcare and insurance-related issues. Eligible employees,
have any frequency limitations, and what to their spouses, dependent children, parents and parents-in-law can use
do to request coverage if you go over them. the benefit.
©2016 Health Advocate HA-M-1510041-1FLY
Get started
Four Key Steps Questions about a denied claim?
Stay “in-network.” Most denials occur Your Personal Health Advocate can help you sort it out
because patients use providers who are out of to get the bill reprocessed for payment. We can….
their plan’s network for their care. Before you
even make an appointment, always confirm • Look for duplic ate billing. For example, a medication may have been
that your providers, hospitals and other billed when it was prescribed and then again when it was administered.
medical facilities are “in-network.” • Check for incorr ect coding. The treatment or procedure code may
Get appropriate pre-approvals prior to not match the diagnosis code.
receiving services. Check to see if your plan • Address lac k of preauthorization. If your doctor ordered an MRI,
requires a pre-certification, pre-authorization for example, we can work with him or her to obtain the proper
or referral for services to cover them. authorization to get the claim paid.
Double check that your information is • Obtain proper documentation. Some bills are denied because the
complete. Make sure your personal informa- insurance deemed them not medically necessary. We can work with
tion including your name and health insurance the doctor to get any required paperwork that may be needed.
number is correct on the paperwork.
• Review for data entry err ors. We’ll check that your current health
Understand frequency limitations. Benefits policy was entered correctly and look for typos.
for certain services such as mental health
counseling, may have limitations for the Remember… your Personal Health Advocate can help you understand
number of visits that will be covered by your your coverage, obtain pre-approvals, handle denied claims and assist with
insurance company. Check to find out if you a variety of healthcare and insurance-related issues. Eligible employees,
have any frequency limitations, and what to their spouses, dependent children, parents and parents-in-law can use
do to request coverage if you go over them. the benefit.
©2016 Health Advocate HA-M-1510041-1FLY
