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Comments on Pre-authorization received, payment denied

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.

Sincerely,

Dr. S

Thank you to Dr. S for the helpful tips!

Have a comment or question on an applicable topic you care to share? Email me at Jennifer@Kirschenbaumesq.com or call (516) 747-6700 x. 302.

 

Copyright © 2011 by Kirschenbaum & Kirschenbaum, P.C.

All Rights Reserved. This email is provided for news and information purposes only and does not constitute legal advice or an invitation to an attorney-client relationship. While every effort has been made to ensure the accuracy of the information contained herein, Kirschenbaum & Kirschenbaum PC does not guarantee such accuracy and cannot be held liable for any errors in, any reliance upon this, or losses caused by the information. Under New York’s Code of Professional Responsibility, this material may constitute attorney advertising. Prior results do not guarantee a similar outcome.


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