Dealing with Health Insurance Claim-Processing Companies
Part 1: The Basic Tools, Chapter 3: Developing a Systematic Approach to Dealing with Health Insurance Page 23
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If following these steps does not lead to a resolution of the problem, you have several additional choices. One possibility is to talk with a private medical claim-processing company. For years, many doctors and hospitals have employed claim-processing companies to file claims or to deal with problems related to claim-processing. Over the past few years, many of those companies have begun to work for consumers, as well, helping to solve claim-processing problems.
At this point, there are no national licensing requirements for private medical claim-processors, and there are no national rules or regulations in terms of procedures or charges. Each medical claim-processing company has its own approach to dealing with claims, and charges vary from company to company. Some medical claim-processing companies charge a fiat monthly fee for processing claims. Other companies charge an hourly fee, and others charge on the basis of a percentage of the total claim.
You may be able to locate a medical claim-processing company by looking in the telephone book or in your local newspaper. The National Association of Claims Assistance Professionals (NACAP), which has 1,500 members at present, can also help you locate a medical claim-processing company in your area (See Appendix B). Some members of NACAP focus primarily on claim-processing for medical providers. Other claim-processing companies work with both medical providers and consumers, or with consumers only.
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