Phone script: ask for reprocessing
What to say to your plan and to the provider's billing office to get a paperwork denial corrected and the claim processed again.
- Private: nothing leaves this tab
- A template, not legal advice
When to use this, and what it is not
When to use this. When a denial looks like a paperwork or coding problem, such as a wrong code, wrong date or missing information. Call the plan first, then the provider's billing office. Asking for reprocessing is not an appeal, and you should not assume it changes your appeal deadline.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the script
Your script
Date of this call: [Date of the call] With the plan (number on your card): 1. Say: "I am [Your name], member identification (ID) number [Member ID]. I am calling about claim [Claim or reference number], date of service [Date of the care]. I think it was denied because of a paperwork problem: [What looks wrong on the claim]." 2. Ask for the person's name and a call reference number. Ask whether the call may be recorded, and write down their answer. 3. Ask: "What is the exact denial code, and what does it mean in plain words?" 4. Ask: "What must be corrected, and who sends the correction: the provider or me?" 5. Ask: "When the corrected claim arrives, will you reprocess it? How long will that take? Will I get a new Explanation of Benefits?" 6. Ask: "Does asking for reprocessing change my appeal deadline?" Write down the answer. Keep the original deadline unless the plan changes it in writing. With [Doctor, hospital or pharmacy]'s billing office: 7. Say: "My plan says claim [Claim or reference number] was denied because of [What looks wrong on the claim]. Please send a corrected claim. When will you send it, and will you tell me when you have?" 8. Write down the name of the person and the date they promised. 9. Write down for each call: name, ID number, date, time, reference number, the promised action and the date. 10. Close each call: read your notes back and ask, "Is that right?" Say, "I will call again on the date you gave me."
Before you call
Call the member services number on the back of your insurance card, then the billing office number on the provider's bill. Ask for a call reference number at the start and again at the end of each call.
What happens next
- Call back on the date you were promised. If the claim is not fixed, file your appeal, and do not wait past your deadline.
- Ask the provider to hold the bill while the claim is corrected. The bill hold letter on this site is written for that.
- Check the new Explanation of Benefits when it arrives. If the denial remains, ask for the reason in writing.