Currently insurance claim denial appeals have to be reviewed by a licensed physician. I bet insurance companies would love to cut out the human element in their denials.
A real world response to denied claims and prior authorizations is to ask a few qualifying questions during the appeals process. Submit claims and prior authorizations with the full expectation that they will be denied, because the shareholders must have caviar, right?
Anecdotal case in-point:
You desperately need a knee surgery to prevent a potential worse condition. The Prior Authorization is denied.
You have the right to appeal that ruling, and you can ask what are the credentials for the doctor who gave the ruling. If, per se, a psychologist says that a knee surgery isn’t medically necessary, you can ask them which specialized training they have received in the field of psychiatry that brought them to that conclusion.
Currently insurance claim denial appeals have to be reviewed by a licensed physician. I bet insurance companies would love to cut out the human element in their denials.
Did someone order a Luigi?
I’m really interested in seeing the full text whenever that comes out, I agree and think this would be one of the first places they would use it.
A real world response to denied claims and prior authorizations is to ask a few qualifying questions during the appeals process. Submit claims and prior authorizations with the full expectation that they will be denied, because the shareholders must have caviar, right?
Anecdotal case in-point:
You desperately need a knee surgery to prevent a potential worse condition. The Prior Authorization is denied.
You have the right to appeal that ruling, and you can ask what are the credentials for the doctor who gave the ruling. If, per se, a psychologist says that a knee surgery isn’t medically necessary, you can ask them which specialized training they have received in the field of psychiatry that brought them to that conclusion.
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