I work for a hospital and I am asked to write appeals to insurance co. Have a hard time wording my sentences.

Question

I always dont know how to word my appeals correctly. I seem to make my letters to short with not enough information. I

Answer 1

I feel bad for you. This is your job. It is an important one. You seem to not be equipped to perform it. I am in no way trying to be rude or malicious or mean or all of the above but you have to do some research...go over some old course studies books...ask colleagues for help. Show some manner in your professionalism to step up to the plate so that you can do you job properly.

Answer 2

Asking for a denial reason in writing is often time-consuming, it's usually printed on the EOB or you can get it by a phone call to the claims department. You want to make them reconsider their decision, correct?

Basically you want to show the insurance company that it is more cost-effective if they pay for whatever it is you're asking for vs. worst-case senario. For example - I had to appeal a denial for the RSV (Synagis) shot for a premie. This shot costs about $1500 a dose, one dose a month, for six months. I put it in dollars and cents for them - would they rather pay $1500 a month for preventative or $10,000 a DAY for an ICU hospitalization?

The other thing you want to address - and you should use this as the primary reason for the appeal - hit 'em with the dollars and cents secondary - is medical necessity/medical prudence. Like for a rhinoplasty to fix a fractured nose, vs. a cosmetic fix. If a fractured nose isn't fixed, it can lead to breathing issues - that's a medical necessity. A treatment for someone that can keep them from having an extended hospitalization - that's medically prudent.

Also - provide as much documentation as you possibly can to back up your request. You also need to do this quickly - providers have a limited appeals window, usually less than 45 days from date of denial, after that you're out of luck.

Good luck!

Answer 3

find older appeals in your archives that fit different situations. reword them 2 fit your current need. eventually u'll create a style thats more your own and u wont need a 'template' anymore. if all else fails, or u cant access archived files, ask a supervisor 2 critique your appeal and make modifications based on that. dont want your supv to think u're inept? send it to th insure co the best way u c fit, then wait for the insure cos. response. if they ask 4 more info, then u know 2 include more next time. trial & error, but if u like what u do, u'll make it happen.

Answer 4

Your appeal should NOT be wordy. Just say something like: "Please tell me why this claim was denied." You will likely have to send out a lot of these letters, so it's best if they are NOT wordy.

When you get your response from the insurance company, THEN you will need to have access to records (so you can remember the case) and better writing skills-- so you can argue with them. Be prepared to get the doctor to add his or her account of the case. It's the doctor and hospital who are losing money if a claim is denied, so make sure to involve them IF the insurance company argues with you.

I hope this was helpful!

Answer 5

I'd love to help but don't nearly have enough info to do so...
What are the letters intended to do? Make the insurance companies pay?

Answer 6

Oh, I choose i might desire to write one daily. proposal would not come that at as quickly as to me. If I write 3 a week, then I evaluate i'm on precise style. i think of there's a poem in each person, if in easy terms they might attempt

Answer 7

Well, less is more when it comes to writing especially to insurance companies. You haven't really told us the main issues you write about, so I can't help you much.

Answer 8

pretty good job. just get a punctuation book and write. it dosent have to be formal, just do the best you can and keep up the good work!

Answer 9

It sounds like your not qualified for the job, but don't worry they will tell you.

Answer 10

Haha. You made this one too short too, hon. :)