California Health & Safety Code §1371.4; 28 C.C.R. 1300.71 Health plans are required by California law to reimburse emergency providers directly for the reasonable and customary value of emergency services the provider rendered to the health plan’s insured member.
When it comes to appealing denied health care coverage, the biggest challenge may be the time and effort it requires to appeal a claim denial. The process can feel overwhelming and time constraints force medical providers into situations where they feel powerless or in many cases, forget to file.
Physician practices that are losing a significant amount of revenue and administrative time due to low reimbursed and denied insurance claims may be able to reduce those losses by regularly conducting
litigation and claims analysis.
In appealing denied insurance claims, you need to have the mindset that it is the insurance carrier's burden to prove that the claim has been processed correctly and that any ambiguities in the coverage terms were construed in the insured's favor.
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