September 26, 2011

Great tips on pressing for reimbursement from a colleague -

Dear Jennifer,

I read with interest the articles regarding preauthorization and subsequent denial. I can't begin to tell you how many times this happens in my practice (general surgery). Try re-possessing an operation that has already been performed. In addition, when the insurer denies the claim for service, it gets denied across the board--surgeon, hospital, anesthesia. My experience is that it can take as long as six months for resolution.

Tactics that my office uses that seem to work: 1. Contacting the NY State Insurance Commission. 2. Threatening the insurer with calling the NY Times and exposing them. We have been doing this a lot lately, and it actually works. The insurers appear to be taking the threat of negative press seriously. Usually within a few hours of my issuing the threat, my office will get a call from a supervisor at the insurer telling us that the claim has been reprocessed. They then want a guarantee that we will not contact the press. The biggest offenders are (in order): Oxford, HIP, and Blue Cross.

Thank you for spreading the word. You continue to provide excellent information and insight into many of the problems plaguing physicians today.


Dr. S

Thank you to Dr. S for the helpful tips!

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