Appeal Process

[CIA_2019]

Hello Billing Family!

I am at a cross road with Blue Cross. I have a PDN elderly client. I've submitted several claims to BCBS and they were all denied. They are stating that the services are experimental. I am thinking I need to file an appeal. What is the process of an appeal and will they then pay for the services? I've been fighting for this patient for over a year now.

Also, how do I build up the appeal to be paid?


Thank so much!!

[Michele]

Were benefits verified prior to the services? 

There is no way to tell if they will pay.  It depends on if the patient's plan covers PDN for the reason they required it.  I would include a letter from a doctor stating the need for PDN, and any other information that you have supporting the need.