not-work-related denial
Steve, I have especially appreciated learning from your posts and your book, INSURANCE BILLING AND COLLECTION COMPLIANCE, about how to address denials with appeals/letters that quote sources with...
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And if I'm not misreading the question, at this point you would bill the patient. If it's an existing patient and you alread have his health insurance information I'd bill them, too.The denial is that...
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I just dealt with this very issue when a patient complained to the Department of Health, so now they are investigating my doctor. No problemo, I sent them a 12 page letter outlining the whole...
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Your reasoning for being able to bill the patient is so helpful.Certainly sounds reasonable. My only hesitation now would be 1) the DWC/TDI Customer Service having told me several times by phone that...
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I'm not sure where you're getting two "other" conditions because there are only two conditions in the clause you cite:(1) the injury is finally adjudicated not compensable under this subtitle; [which...
View ArticleRe: not-work-related denial
(There were three listed when I found it. Diff version?)BUT, I guess my sticking problem is the "finally adjudicated" part. In the past, when I rec'd the denial, I thought the carrier was the one who...
View ArticleRe: not-work-related denial
The insurance company is never the final adjudicator of the case. The state dept is. Sharon
View ArticleRe: not-work-related denial
I think your problem is your taking the instructions you received in one specific case and applying that answer to every situation in general.A DWC-45 is a request to open a hearing on a dispute. Of...
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Well now, I think I ended my post a little too quickly. If the work comp insurance company denies, and the patient does not take it further, then bill the patient. But if the patient appeals the...
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I'm glad Sharon raises this point. I deleted my initial response, in which I advocated not appealing and instead billing the patient, because after re-reading cc's post I had second thoughts, based on...
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Okay, reading the recent posts made me go back and reread the OP, because y'all had me thinking I imagined things in the post that weren't really there!The way I read it originally, and I still read...
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Re: not-work-related denial
Wait a minute now, I think you're right. Never mind then... CBTGIF!
View ArticleRe: not-work-related denial
Ok, here I go, about to put my foot in my mouth,1. There is a denial of the claim.2. The reason for the denial is: this is NOT a work related injury.When a claim is denied, it has been adjudicated. It...
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