Tips for Handling Claims Denials

The U.S. insurance system has a well-documented history of using delays, denials, and general nonsense to save billions of dollars. However, patients and providers are often caught in the middle. This is especially true with mental healthcare, leading to the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) law and subsequent federal regulations to try to ensure greater healthcare parity.

Fortunately, there has been some excellent reporting on methods insurance companies use to avoid paying out claims and what individuals can do to try to counter these maneuvers, such as the articles linked below:

• What to Do When Health Insurance Denies Care You Really Need: Introductory explanation for dealing with claims denials and provides concrete tips.
• Bill of the Month: Explores a medical bill every month, getting into nitty gritty coverage issues and insurance company tactics.
• First Aid Kit Newsletter: Offers practical tips for consumers trying to navigate our complex healthcare system.

Here’s a high-level summary of tips for providers and clients:

• Get it in writing
  • If an insurance representative makes any promises about treatment or provider coverage, it’s important to get this in writing so it’s harder for the insurer to dispute later
• Double check paperwork for simple errors
  • Make sure the paperwork accurately reflects client’s information and uses the correct billing codes
• Document your efforts
  • Keep evidence of the claims you’ve submitted, the denials you’ve gone through, and your time lost in dealing with insurance companies. This information can be used as evidence when appealing to state insurance commissions and external appeals. It also tells a powerful story that you can share when interacting with policymakers. [1]
  • When speaking with the insurance company, write down the representative’s name, the date and the time of the correspondence. This creates an informal record and can help you hold the insurance company accountable for any promises the representative makes
• Escalate as necessary
  • It may be necessary to file multiple appeals, get an external review and/or file a complaint. Check out this Health Insurance Appeals Guide for information about filing appeals
• Keep an eye out
  • Look out for new and ethical HIPPA- and ACA Ethics-compliant tools to support your billing process

ACA will continue advocating for greater mental healthcare parity and fair compensation for counselors. Stay tuned for more policy updates and advocacy resources. For more information or if you would like to become involved in ACA’s advocacy efforts, please contact the Government and Public Policy team at advocacy@counseling.org.

[1] In accordance with ACA Ethics, you cannot provide any identifiable information about your clients without their prior consent. Instead, we recommend speaking generally about what clients go through when denied coverage and how insurance practices impact your ability to provide care. If you would like to discuss the experiences of a specific client, you must seek their (or in the case of minors, their guardian’s) consent, and we would still strongly recommend removing any identifiable information.