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Insurance Claims: Tips for Negotiating Claims with Insurance Companies

Negotiating an insurance claim

When healthcare providers and staff understand how to communicate with insurance companies, it can make billing and medical claims processing much easier. It’s not uncommon for an insurance adjuster to offer an initial settlement at a lower amount than you requested. Negotiating a final settlement can have a positive impact on your business.

It’s imperative to first determine what you believe your medical claim is worth and decide on a minimum settlement figure that you will accept. When you receive an offer that seems low, ask the insurance company to give you specific reasons why the offer is so low. Then follow up by writing a brief letter responding to each of the facts the insurance company mentioned.

It’s also helpful to mention emotional suffering the patient

experienced in your letter and conversations. There is no way to put a dollar value on life changing health issues and they can be a powerful way to influence a higher settlement. For example, you may want to include a photo of a severe injury and mention the impact on the patient’s ability to perform daily work or life routines.  

During the negotiation process, if the insurance company provides some facts that you had not considered, you may have to lower your figure a bit. Typically within two to three conversations you can agree to a settlement amount somewhere in between your desired payment and their offer. Once you reach an agreement, follow up with a short letter confirming the amount offered.

Remember it’s not advisable to take the first offer you receive from an insurance carrier, even if it is reasonable. It always helps to make a counteroffer that is fair. During a phone call with the insurance adjuster, you can discuss the strengths and weaknesses of your claim. With a little bargaining, you can often get to an agreement that is better than the initial offer and satisfies both of you.  

Submitting medical claims and negotiating settlements with insurance companies is a process that Apex EDI knows and can help you with. We want to make sure your practice thrives and that you receive the maximum payment you are entitled to. Contact Apex EDI to request a free demonstration of our medical billing software today.

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