nge? W
@bodhipaksa
#Insurance #advice
Text version, not just Alt text...
To everyone in a similar scenario: the tactic my doctor's office has taught me is to ask, in writing, for:
1) the name, board specialty, and license number of the #doctor making the determination the #treatment was not #medically necessary;
2) copies of all materials they relied on to make their determination;
3) proof the doctor making the determination has maintained registration in your specific state and #documentation of their meeting all their continuing #education #requirements;
4) the aggregate rate at which similar treatments are denied vs approved by the specific doctor being used for peer review.You are not entitled by #law to *all* of these things in most #states, but you're entitled to some of them, and you can always ask for them.
This is, she says, a wildly successful tactic, because if the insurance c#ompany answers them honestly, it gives you #evidence that the"doctors" making these determinations are practicing #medicine out of scope, without proper #licensing and #qualifications, in areas they are not competent in.
Everyone knows this is true; it's not a secret in any way. But it's in violation of a number of regulations, and a LOT of times the company will just give up and pay the bill rather than handing you proof they're violating the regs. It's a tactic that has worked for me many, many times.
rahaeli on Bluesky posts the above.
