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I am a below knee amputee. More importantly, I am also Mommy to two boys, a very active 10 year old (Robby) and an mischievous toddler (Timmy). I have learned that being a parent with a disability can create some unusual and sometimes humorous situations. This blogger is available for hire! Let's talk and learn how a blog can expand your business.

Friday, February 24, 2017

Your Insurance Denial Battleplan

Helping individuals fight their insurance companies to obtain the devices that are both necessary and entitled policy benefits has become a professional highlight. Over the past decade, rubber stamp denials have become the industry norm. I suppose that these multi-million dollar companies are hedging their bets that people will become lost in the sea of red tape and eventually give up pursuing their benefits. Enough people must accept the denial to make the process profitable for the insurance company, otherwise claims would have always had a fair review upfront. 

Declaring a device or component "Not Medically Necessary" is one of the hallmark rubber stamps used by insurers. This often blanket verdict is baffling for the patient and cumbersome for the practitioner to fight. Although it shouldn't be this way, far too often the patient is left to fight for the device with little or no support from the provider.  Ideally the prosthetist would take the lead during the appeal process, but the emails I receive from frustrated patients tells a different story.

Dave, my podcast partner, and I have been talking for years about providing a guide for individuals to fight their insurance denials. We have wanted to map out the method that we have both successfully utilized to overturn denials during the appeal process. In full disclosure, I can lay no claim to the method. I learned it from Dave during a seminar and have applied it (with success) through the years.

In last week's podcast, we finally walked through the process to fighting an insurance denial on the basis of medical necessity. We have provided a clear method to drafting an appeal with the greatest likelihood of overturning the denial. While nothing is 100%, we believe that following the steps that we have outlined and explained provides the best chances for a positive outcome.

I always feel more comfortable writing something after reading an example. With this in mind, we have created and included a full appeal on our website. It is our hopes that, by using the steps we outlined in our podcast and after reading the example, patients will have a better chance at obtaining the devices that they so desperately need.  If you have any questions, please don't hesitate to reach out to us either through this blog or ampdpod@gmail.com. 

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