Any advice on submitting an appeal regarding a medical insurance claim? I’ve found templates for appeals for claims denied, but not for appealing the amount. The CPT code is correct (87506). Our insurance is high deductible but we went in network (Kaiser).
$698 for a single stool test ($1249 before insurance). A second stool test (87505) was a second part of this claim and it was billed as $609 and fully covered as far as I can tell.
I’ve used FairHealthConsumer.org to find the normal cost of this test and it gives $237 as the in-network cost for 80% of these tests. Should I include this information in my letter of appeal? I have to mail it to the insurance appeals department across the country.
What angle should I take? Write about how difficult my medical issues were? Write about financial hardship? Stick to the logical cost argument? Take the moral angle of how taking advantage of people through such a markup is wrong? Tone of plea, anger, or cool logic? Handwritten or typed?
Do I need to ask my doctor to write a note to include? If so, what should it contain?
Separately, I’m relatively new to Reddit, so can anyone tell me if there is a community specifically for exposing medical bills that I haven’t found yet? So if something like this were to happen to someone else, there would be a thread for, let’s say, “colonoscopy,” and everyone could post their cost pre- and post-insurance? People post their costs on costhelper.com, but there is no ability to reply or give advice. Enough people deal with this that surely there is a way to band together online and increase transparency. I requested to post in r/MedicalBill a while ago but was never approved, so am posting here.
Thanks!
submitted by /u/Best-Huckleberry-483
[link] [comments]Any advice on submitting an appeal regarding a medical insurance claim? I’ve found templates for appeals for claims denied, but not for appealing the amount. The CPT code is correct (87506). Our insurance is high deductible but we went in network (Kaiser). $698 for a single stool test ($1249 before insurance). A second stool test (87505) was a second part of this claim and it was billed as $609 and fully covered as far as I can tell. I’ve used FairHealthConsumer.org to find the normal cost of this test and it gives $237 as the in-network cost for 80% of these tests. Should I include this information in my letter of appeal? I have to mail it to the insurance appeals department across the country. What angle should I take? Write about how difficult my medical issues were? Write about financial hardship? Stick to the logical cost argument? Take the moral angle of how taking advantage of people through such a markup is wrong? Tone of plea, anger, or cool logic? Handwritten or typed? Do I need to ask my doctor to write a note to include? If so, what should it contain? Separately, I’m relatively new to Reddit, so can anyone tell me if there is a community specifically for exposing medical bills that I haven’t found yet? So if something like this were to happen to someone else, there would be a thread for, let’s say, “colonoscopy,” and everyone could post their cost pre- and post-insurance? People post their costs on costhelper.com, but there is no ability to reply or give advice. Enough people deal with this that surely there is a way to band together online and increase transparency. I requested to post in r/MedicalBill a while ago but was never approved, so am posting here. Thanks! submitted by /u/Best-Huckleberry-483 [link] [comments]Read Morer/HealthInsurance