Print Denial reason group 6 Your insurance company has denied your claim for the following reasons: Charges exceed your contracted/legislated fee schedule Usual and customary reductions (UCR) Steps you should follow to appeal insurance denials: Contact your insurance company to verify if Mayo Clinic is contracted and in network with your policy. If yes, request that your insurance company reprocess the claim and pay per the contract with Mayo Clinic. If no, did you need/obtain a referral? If yes, ask your insurance company to reprocess the denied charges. If no, ask your primary care physician to submit a referral authorization. Was your service provided in an emergency room? If so, contact your insurance company to review your policy for emergency care coverage. Request that the claim be reprocessed if you are covered as in-network for emergent care. If you do not have in-network emergent care, appeal the denial with your insurance company. Request a detailed itemization of the denied charge from your insurance company. Request an explanation of the factors the insurance company used to determine that your charges were higher than those being charged by other providers. Ask your insurance company to provide you with a list of the prices of other providers to which your charges are being compared. Some states are now requiring provider pricing transparency; check the website of the provider you received care from. Below are a few pricing links. www.nlm.nih.gov www.mnhospitals.org/data-reporting/minnesota-hospital-price-check/hospital-report https://price.healthfinder.fl.gov/ www.healthcarebluebook.com www.newchoicehealth.com Jan. 25, 2024 ART-20203485