Our Services For Families
866-322-0787
What We Do
Making your family financially whole again
Dealing with medical billing denials can be a huge burden on families, both emotionally and financially. It’s tough to navigate the complexities of insurance policies and claim procedures, especially when dealing with medical, behavioral health, or substance abuse issues. But you don’t have to face this challenge alone. Our team of expert healthcare advocates at FixMyClaim is here to help you fight for your rights and make your family financially whole again. We offer a range of support services, including claims and appeals assistance, to help you overcome the obstacles and red tape associated with insurance denials. Let us help you resolve your specific insurance problems and get the coverage you deserve.
Unmatched Experience in Medical Billing Denials: Trust Denials Management as Your Advocate
When it comes to advocating for families facing medical billing denials, FixMyClaim stands out from the competition. Since 1990, our experienced team, formerly known as Denials Management Company, has been helping families gain just compensation for denied claims due to medical necessity. With our in-depth knowledge of insurance regulations and processes, we are equipped to navigate the ever-changing world of health insurance on your behalf. Our main goal is to ease the burden of fighting medical and insurance denied claims and help your family become financially whole again. If your medical insurance has denied a claim or you’re struggling to get the information you need from your insurance company, contact us us today and experience the unmatched advocacy of FixMyClaim.
Insurance Policy Review
We provide insurance policy reviews to help you understand what your current policy covers before you seek medical treatment or a new provider.
Insurance Claim Denials
FixMyClaim can assist with all types of claim denials, including medical, mental health, and prescription drug claims, and has experience fighting all types of denials to ensure you receive the coverage you deserve.
Filing Complaints
To ensure that your health insurance claims and appeals are treated fairly, we can assist you in filing complaints against health insurance companies for stalled claims or unfair treatment.
Verification of Benefits
Our company provides a verification of benefits service for medical insurance, which involves confirming a patient’s eligibility for coverage and the specifics of their insurance plan, such as deductibles, co-pays, and maximum coverage limits.
Pre-Authorization & Utilization Management
Preauthorization and utilization management of medical claims appeals refer to the process of obtaining approval from an insurance company before receiving medical treatment and ensuring that the treatment is medically necessary and cost-effective.
Medical Billing
Our company offers medical billing services that simplify the process of paying for healthcare expenses for families. By collaborating with healthcare providers and insurance companies, we ensure that medical bills are processed accurately and efficiently, reducing the stress and hassle of managing medical expenses.
Administrative Appeals
Our team submits requests for additional review of denied claims to the administrative department of insurance companies, bolstered by additional evidence and documentation that supports the medical necessity of the treatment or procedure.
Consulting
Our consulting services can assist you in navigating the appeals process and increasing your chances of obtaining coverage for your medical expenses. Our team of experienced professionals can review your medical bills and insurance policies, provide advice on the most effective course of action, and help you understand your coverage options.
Attorney Coordination
We offer attorney coordination services if you require legal assistance for your case. By working closely with the legal team, we gather all necessary information and documentation to present the case effectively, resulting in a streamlined appeal process and the best possible outcome for you.
Types of Insurance
Our services cover a range of health insurance types.
Learn More
Certainly, here’s a brief explanation of each healthcare insurance type that our services cater to:
- Medical insurance: This type of insurance provides coverage for medical expenses, such as doctor’s visits, hospitalization, and prescription drugs. Medical insurance may also cover preventive care services, such as annual check-ups and vaccinations.
- Dental insurance: Dental insurance covers dental care expenses, such as routine check-ups, cleanings, fillings, and other dental procedures.
- Pharmacy insurance: This type of insurance covers prescription drugs and may also provide coverage for over-the-counter medications, depending on the policy.
- Supplemental insurance: Supplemental insurance is designed to provide additional coverage for expenses that are not covered by other insurance policies. Examples of supplemental insurance include cancer insurance, critical illness insurance, and accident insurance.
Our team of experienced professionals can also assist with appeals related to mental health and substance abuse coverage, which is an essential aspect of healthcare insurance. Additionally, we provide guidance and support for appeals related to life insurance, which can help you secure the coverage you need to manage your medical expenses. By working with us, you can navigate the appeals process with ease and increase your chances of obtaining the coverage you require.
Reason for Healthcare Claim Denials
Medical claims can be denied due to a multitude of reasons, including coding errors, incomplete information, lack of medical necessity, or exceeding policy limits.
Learn More
Medical bill claims can be denied for a variety of reasons, including:
-
Medical Necessity: The service or treatment provided was not deemed medically necessary by the insurance company.
-
Excluded Service(s): The insurance policy does not cover the specific service or treatment received.
-
Experimental/ Unproven Procedures: The service or treatment received is considered experimental or unproven and not covered by the insurance policy.
-
Mental Health Parity: The insurance policy does not provide the same level of coverage for mental health and substance abuse treatment as it does for physical health treatment.
-
No Pre-Authorization: The insurance policy requires pre-authorization for certain services or treatments, which was not obtained prior to receiving the service or treatment.
-
Out-of-Area: The service or treatment received was outside of the insurance policy’s approved coverage area.
-
Reasonable & Customary: The insurance company deems the amount charged for the service or treatment as unreasonable or not customary for the area.
-
Processing Errors: The claim was denied due to errors in processing or submitting the claim.
-
Custodial Care: The insurance policy does not cover custodial care, which is care that helps with daily living activities but does not require medical training.
-
Timely Filing: The claim was not submitted within the insurance company’s required timeframe.
-
Coordination of Benefits: The claim was denied due to another insurance policy being primary for coverage.
-
Provider Definition: The provider who performed the service or treatment is not recognized by the insurance company.
-
Urgent & Emergent Care: The service or treatment received was not deemed urgent or emergent by the insurance company, and therefore not covered.
-
COBRA: The insurance policy was obtained through COBRA, but the policyholder failed to pay their premiums on time, resulting in the policy being terminated.
Your Rights to Appeal
Knowing your rights empowers you to navigate the healthcare insurance system effectively and increase your chances of obtaining the coverage you require.
Learn More
It’s crucial to understand your rights when it comes to healthcare insurance coverage. Unfortunately, many people are unaware of their rights, and the information may not be readily available. Large insurance corporations can be intimidating to question, which may discourage people from researching their rights further or challenging a claim decision they feel is unjust. However, it’s essential to remember that you have several rights if your medical insurance denies a claim. These include:
- Obtaining a full, fair, and thorough review of your appeal
- Collecting copies of all documentation related to the denial of your claims
- Receiving copies of your insurance plan documents
- Obtaining expert claim representation and assistance throughout all levels of the administrative appeal process
- Filing insurance department and employer complaints on claims and appeals that are stalled
- Requesting independent medical reviews for several denial reasons after internal appeals are exhausted.
Denied for Medical Necessity
FixMyClaim helps familes navigate the challenges of claims that are denied due to medical necessity.
Learn More
FixMyClaim helps families with medical insurance claims by ensuring they are submitted correctly and responded to fairly. One common reason for denial is medical necessity, which is when the insurance company does not believe the treatment received is necessary. However, medical necessity denials can be appealed. To appeal, a detailed timeline of events that led to the treatment must be provided. Different insurance providers have differing medical necessity criteria, but we are experienced in building strong arguments against this type of denial. There are two internal levels of appeal before an independent review board (IRO) can be requested. The IRO is made up of medical professionals not affiliated with the insurance company, but if the IRO upholds the denial, litigation may be difficult. FixMyClaim works with families to determine the best path for their situation.
Filing an Complaint Against the Insurance Company
If you believe that an insurance company has acted unfairly or improperly, you may be able to file a complaint.
Learn More
If you believe that an insurance company has acted unfairly or improperly, and are not satisfied with the response from the insurer’s customer service department, file a complaint with your state insurance commission. Some common reasons for filing a complaint include:
- Timely filing: The insurance company did not process your claim within the required timeframe.
- Coding problems: The insurance company incorrectly coded your claim, resulting in a denial or incorrect payment.
- Additional information needed: The insurance company requested additional information to process your claim, but did not provide clear instructions or adequate time to submit the information.
- Unprocessed claims: The insurance company did not process your claim at all, resulting in a denial or no payment.
- Processing error: The insurance company made an error in processing your claim, resulting in a denial or incorrect payment.
- Prompt payment error: The insurance company did not pay the claim or pay it in a timely manner as required by law.
- Refund request: You overpaid your premium or were incorrectly charged and need a refund from the insurance company.
Explanation of Our Policy Review Services
With a thorough insurance policy review, FixMyClaim can analyze your policy to determine if your health insurance denial was issued in error and advise you on your next steps.
Learn More
When your insurance claim is denied, one of the first steps you should take is to review your insurance policy. Many individuals are unaware of their right to receive copies of their insurance plan documents and documentation related to their claim denial. You can obtain this information by contacting the individual or organization that issued your insurance. If your insurance was issued through an employer, contact your employer, and if it was issued through the healthcare marketplace, contact the marketplace. Even if they cannot provide you with a copy of your plan booklet, they can direct you to where you can obtain your insurance policy.
An insurance policy review is critical in determining whether your health insurance denial was issued in error. Health insurance carriers insure millions of Americans under thousands of plans, so claims processing centers often default to the most common plan language and terms when deciding to approve or deny claims, resulting in errors. We have discovered several common health insurance denial errors during policy reviews, including incorrect payment amounts, misapplication of preauthorization penalties, and incorrect applications of plan terms and definitions like the definition of medically necessary services.
While this list is not exhaustive, these are some of the most common reasons for incorrect claim denials.