Question

A patient that was recently discharged after a long hospital stay contacts the coordinator about a claim denial from the insurance company. The patient is in a panic because a bill for the charges also arrived. What should the coordinator tell the patient?

Answer 1

The coordinator should advise the patient to review the explanation of benefits for details on the claim denial, guide them on how to appeal the decision, and suggest contacting the hospital's billing department for further assistance and options.

Step-by-step explanation:

If a patient contacts a coordinator about a claim denial from the insurance company and is also concerned about an incoming bill, the coordinator should provide guidance on how to proceed. The coordinator's role is to assist the patient in understanding the denial and the steps they can take to address it. The coordinator can advise the patient to review the explanation of benefits (EOB) provided by the insurance company, which will detail why the claim was denied and provide information on how to file an appeal if the patient believes there has been an error or if additional information can be provided to support the claim.

Additionally, the coordinator should remind the patient that the surgical team, including the surgeon, nurse, and anesthesia professional, are concerned with the recovery and care of the patient and that addressing billing and insurance issues is also an important part of post-hospital care. The coordinator can recommend that the patient contact the hospital's billing department, as they may be able to help with the claim denial and provide options such as a payment plan if needed.