Considering a move to a new insurer, I was asked by a client to review several carrier proposals. In the process, I came across “performance guarantees” for things like claims turnaround time (14 days) and accuracy (97%).
Insurers aren’t quite held to the same standards as airlines; who would fly if 3% of flights crashed! But consider the sheer volume of claims. Estimates are that tens of thousands are processed incorrectly or denied every day.
That’s why you need to carefully read your Explanation of Benefits (EOB)
An EOB will help you spot common errors such as a procedure that has been coded incorrectly; if you needed a pre-authorization or referral for the service; or, if you saw an out of network provider. Denials often happen because of a simple transcription error; e.g., your name is spelled wrong or you were born in 1978 instead of 1987.
Are you one of those who don’t even open your insurer’s mail? It shouldn’t surprise you then, when your doctor’s office calls looking for payment.
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