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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.

Tuesday, March 21, 2017

Writing an Investigational/ Exerimental Appeal

One of my great professional pleasures lies with writing and winning appeals for prosthetic devices. Insurance claims too frequently are subjected to the rubber stamp denial in a quest to deter patients or, at the very least, to delay payment.  This approach must work or the industry would change tactics. I abhor the thought of amputees in need of a prosthetic being bound by needless red tape.

I wish I could lay claim to the method I use when writing an appeal, but it was taught to me by my friend and podcast partner Dave. The method is brilliant in its intuitive simplicity, yet the nuances of presenting information in a specific method stacks the deck in the patient's favor. In this week's episode of amp'd, Dave and I presented the method for writing a strong appeal for an insurance denial on the basis of investigation or experimental.

One of the lingering side effects of the Medicare LCD from 2015 is the resurgence in vacuum technology denials based upon being experimental or investigation. The LCD proposal opened the door for insurance companies to change their stance on this thoroughly vetted suspension system. Although elevated vacuum has been around and accepted for more than a decade, and the benefits have been well documented in numerous research studies, patients are being once again being denied this previously accepted suspension system.

We recorded this episode in hopes of helping those who are facing experimental and investigational denials. While we based our sample appeal on a vacuum denial, the system can be tailored for any device deemed experimental or investigational. Our goal is that the tools we provided will empower patients to fight and appeal their denials. As always, we are happy to answer questions!

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