Aetna claims timely filing limit2/6/2024 Ask your doctor's staff to fix the error and send the paperwork to your insurance again.Ĭall your employer's HR department if you have coverage from your job. That could convince the insurance company to reverse its decision and pay the claim.įor instance, ask if your employer could send a letter - or place a call - explaining why your claim is valid. If your insurance company refuses to pay the claim, you have a right to file an appeal. The law allows you to have an appeal with your insurer as well as an external review from an independent third party. You must follow your plan's appeal process.Check your plan's web site or call customer service.You'll need detailed instructions on how to file an appeal and how to complete specific forms. Be sure to ask if there is a deadline for filing an appeal.If you're filing an appeal, let your doctor or the hospital know. Ask that they hold off on sending you bills until you hear back from your insurance company. Also, make sure that they won't turn your account over to a collections agency.Ĭall your doctor's office if your claim was denied for treatment you've already had or treatment that your doctor says you need. Ask the doctor's office to send a letter to your insurance company that explains why you need or needed the treatment. Make sure it goes to the address listed in your plan's appeals process. Ask for a copy of the letter to keep in your files. The first step in an appeal is called an internal review. It begins when you file a complaint to appeal a denied claim. Your claim will get a second look by insurance company employees who weren't involved in the original decision. If you are in an urgent medical situation, you can request an expedited appeal which requires the insurance company to make a decision within 72 hours.Īfter the internal review, your insurance company will call or send you a letter about its decision. If the insurance company overturns the initial decision, your care will be covered. If it upholds the decision, you still have other options. If you're not happy with the outcome, you can take it to the next level. People who don't work for your insurance company - called an independent third party - will do their own review. Usually, you will have four months from the denial of your internal appeal to ask for an external appeal.Some states and plans may have different deadlines. If you are in poor health, you may file for an outside review before the internal review is done.You may also request an expedited review if a decision is needed quickly for health reasons. In an expedited review, the external review organization must make a decision on your appeal within 72 hours. You can send in additional information to support your claim.Some plans require more than one internal review before you can submit a request for an external review.#AETNA TIMELY FILING LIMIT 2020 HOW TO#.
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