About Denials Management

Your Medical Billing Advocate and Partner in the Fight Against Insurance

Health insurance claim and appeal procedures are ever-changing and we are here to advocate for you! Healthcare providers and families need to have expert advice and resources at their fingertips to navigate all of the complicated administrative appeal processes.

Denials Management, Inc. (originally Claims Management, Inc.) was founded by Mary C. Covington in February 1990 to help manage and fight wrongfully denied insurance claims. Since the company was established, we have been providing thorough policy reviews, medical billing assistance, claims management services, administrative appeals support, and consultation services for providers and patients alike on the specific insurance issues they have been facing. The strength of our success comes from our vast insurance and healthcare industry knowledge, along with our proven and effective claim methods and denial handling procedures.

Mary, who started working for a large health insurer in the 1970’s, is one of the foremost insurance claims and appeals experts in the nation. Her experience, coupled with the skills and knowledge of our staff, makes Denials Management your leading health insurance and medical billing advocate option. In order to play the insurance company’s game, you must know the rules of their game… and no one knows the rules of their game better than the experts at Denials Management, Inc.!

Our Mission

Denials Management, Inc. is the nation’s premier Healthcare & Medical Billing Advocacy Company, delivering families and health care providers high-quality utilization management,  claims processing, and administrative appeal services. While maintaining a superior level of health care and insurance industry expertise, our knowledgeable staff strategically advocates for benefits and reimbursement owed to families and providers. It is our mission to influence the way insurance companies do business, one claim at a time. If you’re experiencing issues with a denied claim from your health insurance, let us help you!

Here are several reasons why a healthcare and medical billing advocate can be a great solution:

  • Estimates vary, but studies have found that up to 95% of denied claims are not appealed. Most people fail to appeal because of the difficulty of wading through this arduous process.
  • A 2006 study by the industry group, America’s Health Insurance Plans, found that external reviewers decide in favor of the consumer about 40% of the time.
  • The National Alliance on Mental Illness found that patients seeking mental health services from private insurers were denied coverage at a rate double that of those seeking medical services.
  • Patients with mental illnesses and substance abuse issues are often forced to make a certain number of outpatient visits before gaining approval to enter a residential facility. That so-called “fail first” process is nearly unheard of on the medical and surgical side and violates MHPAEA.

Facts:

  • In March 2011, a study by the US Government Accountability Office found that 11 to 21 percent of all claims submitted to insurance companies across the United States are denied. With a rise in erroneous claim filing and the number of medical bankruptcies and slow paying claims steadily increasing, we truly believe families cannot afford to let denied claims go un-rectified.
  • The American Medical Association published the fourth annual National Health Insurer Report Card in June of the same year and found an increasing inaccuracy in Claims Payment. Nearly $1.5 billion a year is spent on avoidable administration costs for incorrectly processed claims. Mistakes are not the patient’s or family’s fault. As your insurance and medical billing advocate, Denials Management can help.
  • Figures collected by the Physicians for New Healthcare Policies of California discovered medical bankruptcies accounted for more than 62 percent of all bankruptcies in the United States in 2010.
  • Denials Management, Inc. and its affiliates have been successfully appealing denied insurance claims for over 28 years. In our decades of reviewing and appealing denied claims, it has consistently been our experience that about 70 percent of these denials are reversible in whole or in part.