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.
- May 21, 2016