Denial_Non-Emergency Service_Medical Insurance

Can anybody please guide us how to deal with Non-Emergency Service denial by Medical Insurance?

re: Denial_Non-Emergency Service_Medical Insurance

For whom are you billing? Hospital? Doctor?
Write an appeal; provide medical rationale why patient needed care at that moment and not waiting to see MD in the office

re: Denial_Non-Emergency Service_Medical Insurance

We are biling up for hospital.

re: Denial_Non-Emergency Service_Medical Insurance

Well, one way to look at it is that the denial from the insurer means the patient is responsible for the charges. You can bill them and see if you get paid.

Review the insurers coverage guidelines; most use a prudent layperson guideline and at a minimum pay for a screening exam. EMTALA allows ED's to tell a person that they do not have an emergency and to seek care elsewhere. In practice no one does that but the consequence is that you don't get paid for the service you provided or you have to collect from the patient.

re: Denial_Non-Emergency Service_Medical Insurance

Thanks for helping me out.