What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?
A) Rebill with a letter of explanation from the physician.
B) Write-off the amount on the patient's account.
C) Send the patient a statement with a notation of the response from the insurance company.
D) Appeal the decision with a statement from the physician.

Question

Quizplus · Accepted Answer

The best course of action would be to appeal the decision with a statement from the physician supporting the medical necessity of the service. This will provide an opportunity to provide additional documentation or explanation that may sway the insurance company's decision. Rebilling with a letter of explanation and sending a statement to the patient with a notation of the response from the insurance company could also be helpful steps to take, but they should not replace the initial appeal to the insurance company. Writing off the amount on the patient's account would not be appropriate unless all avenues of appeals have been exhausted and it has been determined that the patient is responsible for the cost of the service.

What Should Be Done If an Insurance Company Denies a Service