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CODING & BILLING
5 There's a rule of equal consideration that insurers owe to their insured.
Insurers may not put their financial interests ahead of those of their policyholders.
They're obligated to treat them with equal consideration.
Always remember: You rendered services in good faith, and you have a right to all the reimbursement you're entitled to.
6 Insurance companies must promptly, thoroughly and fairly investigate claims.
They can't deny claims because they lack information they'd have if they investigated properly. Make sure you provide accurate information and all supporting facts regarding medical necessity. They may use inaccuracies to try to undermine your credibility.
7 Insurance companies must consider all available information.
Insurers often disregard pertinent medical records and/or other supporting documents — including those they've specifically requested. Instead, they cherry-pick facts that justify denial. They can't do that. You can request a list of all records and documents they've reviewed and those they haven't, despite their having been made available.
8 Insurance companies are obligated to provide accurate coverage and benefit information.
Ever had a claim denied because a "covered" patient turned out not to be? State and federal laws protect providers who, to their detriment, rely on false or inaccurate information from insurers. When you verify benefits, document everything, including the first name and last initial of the rep providing it. Insurers like to quote disclaimers like, "this is
