{"id":2946,"date":"2020-09-11T14:17:00","date_gmt":"2020-09-11T19:17:00","guid":{"rendered":"https:\/\/stotlerhayes.com\/?p=2946"},"modified":"2024-05-06T14:19:07","modified_gmt":"2024-05-06T19:19:07","slug":"private-insurance-recoveries-solutions-for-resolving-delayed-or-denied-claims","status":"publish","type":"post","link":"https:\/\/stotlerhayes.com\/private-insurance-recoveries-solutions-for-resolving-delayed-or-denied-claims\/","title":{"rendered":"Private Insurance Recoveries: Solutions for Resolving Delayed or Denied Claims"},"content":{"rendered":"\n<p>At Stotler Hayes, we know that securing payment from private insurance can be an uphill battle \u2013 full of red tape, unforeseen barriers, and multiple appeals.&nbsp; Our clients have sought our assistance to tackle these issues, including erroneously denied claims, delays in processing and payment, and pursuing claims the insurance company deems untimely or uncovered.&nbsp; The most important thing to remember with private insurance is to read and follow your contract\u2014especially the&nbsp;<strong>prior authorization requirements<\/strong>&nbsp;and the&nbsp;<strong>claim submission deadlines<\/strong>.<\/p>\n\n\n\n<p>Private insurance will almost always require a prior authorization for skilled or long-term care. &nbsp;We often see denials due to lack of pre-authorization. Be on the lookout for of any pre-existing condition clauses, as well, and make sure the resident\u2019s diagnosis does not fall into that category. &nbsp;Many protections for pre-existing conditions provided by the Affordable Care Act have been eliminated in the past few years and, consequently, excluded by certain policies. &nbsp;Stotler Hayes recently handled such a case where a provider received prior authorization indicating the resident\u2019s treatment was medically necessary, but the claim was denied due to a pre-existing condition clause.<\/p>\n\n\n\n<p>Always get confirmation of your claim submission through a fax confirmation, email read receipt, or electronic proof of submission, and retain these confirmations where they can be easily located.&nbsp; We often see claims that linger unpaid and the provider will subsequently resubmit the claim only to have it denied as untimely.&nbsp; Without proof of the initial timely submission it can be difficult to recover on these claims. &nbsp;If proof of timely submission can be provided, the insurance company must process and pay the claim as the contract requires.<\/p>\n\n\n\n<p>Many states also have prompt payment laws requiring the insurance company to pay interest on delayed payments.<\/p>\n\n\n\n<p>If you are experiencing delays in payment or claim denials by private insurance companies, please reach out to any of our SHG attorneys for assistance.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>At Stotler Hayes, we know that securing payment from private insurance can be an uphill battle \u2013 full of red tape, unforeseen barriers, and multiple appeals.&nbsp; Our clients have sought our assistance to tackle these issues, including erroneously denied claims, delays in processing and payment, and pursuing claims the insurance company deems untimely or uncovered.&nbsp; [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2947,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"hide_page_title":"","footnotes":""},"categories":[],"tags":[],"class_list":["post-2946","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.3.1 - 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