Although denials are uncommon, they occur. Luckily, the Reimbursement Guarantee covers up to $50, minus patient responsibility, for each telemedicine specific denial. Please submit telemedicine specific denials to the reimbursement team for review. The reimbursement team will review the submission and approve or deny the request.
Reimbursement Guarantee Policy
"If any Reimbursable Claim is denied by the applicable insurance company on the basis that such Reimbursable Claim is not eligible for telemedicine benefits, Chiron Health shall reimburse Provider the lesser of (a) the allowable amount of the claim as contracted with the insurance carrier, or (b) fifty dollars ($50), less any payment collected from the patient for the telemedicine visit. A “Reimbursable Claim” is a claim for reimbursement, (i) arising directly out of Provider’s performance of Telemedicine Medical Services during the term of this Agreement (ii) utilizing the Chiron Platform, (iii) that Chiron Health has determined is eligible for telemedicine reimbursement, and (iv) that has been properly submitted by Provider to an eligible insurance company whose network Provider is a member of at the time the applicable Telemedicine Medical Services are provided. All reimbursement requests under this guarantee must be made to Chiron Health within forty-five (45) days following the date the applicable Telemedicine Medical Services were provided to the Patient. In any given month, reimbursement under this guarantee related to Telemedicine Medical Services performed in that month shall never exceed the fees paid by Provider to Chiron Health for Telemedicine Support Services in that same month."
For a review of your denied claim, please use the following Submission Form. One of our of our Reimbursement Specialists will review your claim, and be in touch with next steps!