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.
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.