How to Dispute a Doctor's Insurance Claim

Most medical and health care insurance claims are sent directly from the service provider to the insurance company, with the patient often unaware what a doctor may have claimed for, until the patient receives the insurance company's summary of services they have paid for. Many disputes can be easily resolved, providing that you remain calm and are methodical in your approach. It is easy to take out annoyance on the person on the end of the telephone, but you are much more likely to be successful in resolving the issue if you remain calm and have an amicable demeanor.

Instructions

• 1

  Request a copy of the bill that your doctor's office remitted to your insurance company. Compare this against the documentation from the insurance company, which should detail the billing codes they have paid against. These codes will help you compare what the doctor billed for and what the insurance company paid for.

• 2

  Confirm that the error is that of the doctor and not the insurance company.

• 3

  Identify where the mistake lies. It may be a simple billing code mistake, or there may be additional charges and other issues that you need to dispute.

• 4

  Call your doctor's office and ask to speak to the person in charge of billing. It is little use explaining the situation to anyone but the billing specialist in the office. Question why the office billed the insurance company in the manner it did. Explain what you are questioning and where you feel there may be errors. No matter what you may believe, do not use an accusatory tone. Give the office time to investigate the issue and provide you with a reasonable answer.

• 5

  Send a written complaint to the doctor's office, if, after a reasonable amount of time (one week) you have not had a response from them. Send a copy of this letter to your insurance company, advising them that you are disputing the claim.

• 6

  Contact your state's health care ombudsman, if the matter continues to be ignored by your doctor's office. They are very familiar with billing disputes and can offer advice and assistance in getting the matter resolved.