HOW TO FILE AN INSURANCE CLAIM:
FIVE TIPS TO HELP YOU GET REIMBURSED

Sometimes the prospect of filing your own insurance claim can seem overwhelming. It is far less complicated than people think! You will receive an invoice at your office visit that you may submit to your specific insurance carrier along with a CLAIM FORM. The claim form for your particular insurance company can usually be downloaded from their website or obtained by mail. In the office I have copies of some of the major insurances carrier claim forms which I can give you at the time of your office visit. You should always check with your insurance company yourself to be sure you are filing with the correct form.

Next, all you need to do is complete the specific insurance company claim form and send that along with your invoice which will indicate you have PAID for the office visit to the insurance company. Sometimes the insurance company may inadvertently send the check to me in which case I will then reimburse you. You will always receive and EOB or explanation of benefits indicating whether or not your claim is paid or denied. In cases of insurance company denial you may need to resubmit or call you insurance company to get a complete explanation of the denial. This is not uncommon. Also if you have not yet met your deductible for your specific health plan you should still submit the claim so the cost of your visit can be counted towards your deductible for the year.

In addition here are five tips that may help you successful receiving reimbursement for a claim.

1. ALL THE INFORMATION YOU NEED IS ON THE INVOICE- Insurance companies notoriously deny claims due to insufficient information; I receive frequent inquiries from insurance companies for information ALREADY ON THE INVOICE. The top left hand corner of your invoice has everything you need to file a claim: the tax ID, medical license number, National Provider Identifier (or NPI), and office location (see the info below directly from the invoice). Do not allow your carrier to deny a claim based on missing information.
2. When submitting a claim only send one invoice per envelope do not submit multiple claims together, doing so only increases your chances one or more will be denied.
3. Be persistent, do not let the paper trail wear you down, if they deny a claim based on missing information resubmit it with the information they requested.
4. Write follow up letters if they do deny your claim.
5. I am a medical doctor and use medical codes. I am not considered a mental health professional and benefits covering my services should not be denied on the basis of an "uncovered" mental health benefits.

I hope this will help! Remember if you have not met your deductible, you have an HMO, or if you have zero out of network coverage your policy will probably not reimburse you for your office visits. All other insurance companies should pay part or all of your costs.

Dr. Judith Aronson-Ramos, M.D.