Physician Appeals

Insurer's deny 10% of claims knowing that 50% will not even be challenged.  I will appeal every denied claim immediately citing the legal basis for payment justification.  Persistent follow-up through 3 levels.  I only get paid when you receive a check.

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Patient Advocacy

Patients have significant legal rights in the appeals process.  As an Appointed Representative, I will construct a strong appeal letter citing all of the legal obligations of the payer.  Assistance with negotiating bills, personal medical coordination with specialists.

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Winning Combination

Working with the doctors office and the patient simultaneously submitting two separate appeal letters will have the greatest impact.  When doctors implement an aggressive appeals program, insurer's are less likely to deny their claims abmiguously.

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Aggressive Appeals Management

Insurance companies have adopted slow processing and underpayments resulting in millions of dollars in lost revenue and a huge burden to patients.   Medical providers simply do not have the time or resources to effectively manage an aggressive appeals program and payers take advantage of this situation.

You can put insurers on notice that denials, underpayments, and delayed payments will not be tolerated.  Establish yourself as very aggressive on appeals.  Then the carrier begins to recognize you as someone who will appeal, they will pay because they know if they don’t, they will hear from you.

I utilize vast data bases that have up-to-date legal information for appealing any type of denial.  I also include a notice of intent to appeal to the external review level.  The insurers have significant overhead cost in the appeals process and sometimes it behooves them to just pay the claim than the cost of appeal defense.

 

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