Case Studies: Medical Claim Assistance & Appeals
Do you need help with a medical claim appeal? Through services such as the negotiation of a denied health insurance claim, management of ongoing medical claims to guard against unpaid medical bills, the resolution of eligibility issues related to medical services and assistance with Medicare problems, Medical Reimbursement Resource has helped many patients and their families. A few instances are detailed in the following case histories:
William M., now a happy, active 7 year-old, was 18 months old when diagnosed with a malignant tumor in his spine. During the following year William spent more time as an inpatient at MD Anderson than at his home. MRR’S intervention allowed his mother to devote 100% of her time to William while his father was able to continue working full time. In addition, due to our ongoing diligence in the claims process, MRR identified numerous bills which were not processed correctly by insurance or balances which were not written off by providers, thus saving William’s parents thousands of dollars.
Melissa is a 12 year old girl who attends a therapeutic school where she receives ongoing therapies addressing several mental health issues. Melissa’s parents contacted MRR for help when their insurance company refused to pay for two years of Melissa’s treatment, claiming that it was “not medically necessary”. This amounted to thousands of dollars of treatment. MRR filed appeals on all of the denials and supported the appeals with pages of medical documentation underlining Melissa’s need for therapy. In addition we produced copies of a state law requiring equal benefits for mental and physical conditions under certain insurance plans. Melissa and her parents won all of their appeals, and as a result of her therapy, Melissa will enter a traditional middle school this year.
Eleanor and Jack C. are professionals with two teenage daughters. Between work and family, they lead full lives. Neither parent has the time to file their family’s ongoing medical claims to both primary and secondary insurance providers or to determine when medical bills should be paid. Due to MRR’s ongoing attention to their complicated insurance coverage, all four family members receive maximum benefits from both insurance providers and final bills are forwarded to the parents to pay in a timely manner.
Ellen C. is a 75 year old woman who is crippled with painful arthritis. MRR monitors her many health insurance issues and ensures that both Medicare and her secondary insurance are paying claims correctly. In addition we facilitate on her behalf with her providers to verify that her bills are valid. When a letter of medical necessity or other documents are needed from a provider to ensure payment of a claim, MRR is there. Mrs. C has several hospitalization policies and a long term care policy, and we file to all insurers for ongoing benefits.
When he continued to receive a $12,000 bill from a collection agency for a hospital stay the previous year, Howard, a Houston businessman, contacted MRR for assistance. He knew that his insurance company had paid benefits and he couldn't understand why his balance was so large. His calls to his insurance company and the hospital had produced no results. MRR facilitated on Howard's behalf between the collection agency, the hospital and the insurance company. After studying Howard's plan and the contract between the hospital and the insurance company, MRR negotiated on his behalf and his bill was reduced to $2,000.