Maximizing your chances of getting an insurance approval the first time.
BACKGROUND
Support staffs for any bariatric surgeon are confronted with daily requests for information, rejections and non responses. Although we are only in control of one-half of the process (with the insurer holding the other cards), there are specific things which can be done to minimize the amount of time spent on each individual claim and maximize your chances of getting it done the first time.


METHODS
This paper explores an attorney/obesity rights advocate's various approaches which successfully lead to the overturning of denials by an insurance company or HMO. Implementing such techniques by the surgeon's office may assist some patients in getting approved without having to hire counsel.


RESULTS
By standardizing certain repetitively sought information, utilizing existing technology and creating comprehensive checklists, providers can comprehensively process patient claims with an eye toward providing all necessary information from the start. In addition, 'local knowledge' of the propensities of particular insurers must be documented and kept in mind so that inevitable requests for additional information can be minimized. Lastly, a 'crash course' in insurance law may assist your patients' chances to get approved.


CONCLUSIONS
Some denials will not be overturned without the assistance of qualified counsel. However, some potential denials can be defeated before they start by carefully documenting files, using technology to provide ample information for the insurance company decision makers, knowing some basic insurance law and by actively seeking your patient's involvement in their claims.
Lindstrom
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Obesity Law & Advocacy Center - San Diego, California, USA. sdwllaw@aol.com
D015390:Gastric Bypass / Q000191:economics*; D015391:Gastroplasty / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*