Your Right To Appeal

Health care and the processing of claim is not a perfected science. Claims get coded incorrectly by providers’ offices, sent with incorrect ID information, or processed incorrectly through benefit plans. For health care consumers, it can take some digging and effort in order to get these matters corrected. Sometimes, it even takes an appeal (or multiple appeals).

Based on a recent article by Money Magazine:

·         15% of health claims are denied

·         14% of denied claims are appealed

·         50% of appeals are successful

As patient advocates for our clients, the McGohan Brabender Customer Care Team acts as the patient advocate – mentioned in section 4 – to help identify errors, craft appeals, and escalate the battle when necessary.

Make sure to check out Money Magazine’s article for more information on your right to appeal!

Update: Express Scripts/Walgreens Negotiations

Express Scripts, the company that administers [Anthem/Empire/UniCare]’s prescription drug Plan has been notified by Walgreens of their intention to leave the network when the contract expires on December 31, 2011.  The parties are still in negotiations and Anthem hopes to have this signed by the end of the year.

We have heard that Walgreens is informing customers of their intention to terminate the relationship at the end of the year with letters.  

Below you will find a Q/A sheet that Anthem has distributed.  Please feel free to use this information as warranted.  As we have more information to share, we will continue to update this blog.

Thank you

Anthem FAQ