Most commercial health insurance carriers maintain a 98% or better ratio of claims being processed correctly. For that small percentage of claims processed incorrectly or denied all together, there is an appeals process, which can be both cumbersome and lengthy.
When a claim is denied, Group Benefits Resources will review the claim for your employees to determine if it was processed in accordance with the provisions of the contract. If a claim was processed incorrectly, Group Benefits Resources will contact the respective insurance company’s claims department for reprocessing.
If a denial is made in error, GBR will assist in filing an appeal. In the event of a legitimate claims denial, an insurance company’s medical director can confer with the attending physician and may determine a claim can be paid. (Assuming medical necessity and “best course of treatment").
GBR asks the correct person, the correct question, the correct way.