Controversies in Denials and Prior Authorizations

In This Training Session You Will Learn:
1. Implication of Mass Health Insurance Denials.
2. Is United 20% Decrease in Prior Auths Meaningful?
3. The Right Way and Wrong Way to Fix Denials/Prior Auths.

[@davidroberts6774]

Insightful as always! Thank you for your content!

[@ahealthcarez]

Thank you for watching and for your comment.

[@daviddobies2993]

Your videos are excellent! Thanks!

[@ahealthcarez]

Thank you for watching and for your feedback.

[@janethehesterman4055]

I worked for a Mobile Lab Service Company and I get Pre-auth denials. We are not a physician. We provide a phlebotomist service to Homebound patients to collect their blood and bill their insurance. Most of our Referring physicians are PCP, Cardiologist which send these patients to us without Pre-auth putting the burden on us. We are out of network with most of these plans. How do we stop these providers from sending us patients without the proper Authorization. We have issues with Blue cross bundling our charges with the lab services and tells us we can't bill the pt because it is a contractual agreement to write off our services. When we tell the patient Blue Cross is not paying their services. Blue Cross threaten to terminate a contract that is not paying our services. Any advice?.

[@ahealthcarez]

It’s tough, but you would have to come to an agreement with the referring doctors on who is going to obtain the prior auth.

[@FreeLancerTanzina-wp7ev]

wow, awesome

[@ahealthcarez]

Thank you for watching.

[@unebonnevie]

Thank you for this video!!! I can see you OK but your voice was in and out at the beginning. Could be your internet connection is not fast enough consistently. Do a speed check on your internet connection, doc 🙂
There was recently a Cigna's denials of coverage up to 94M denials, most of which was done by computer software with only 1.1 secs of looking at the claims. ONLY 0.2% of 93M denials actually appealed! Search for TH-cam videos.
Healthcare in the USA is too much for profits. I understand businesses have to make money, but really.

[@ahealthcarez]

Thank you for watching and for your feedback.

[@strongsociety]

How the hell is this legal?

[@ahealthcarez]

Many things in US Healthcare should probably be illegal. Thank you for watching.

[@strongsociety]

Of course! Thank you for sharing your knowledge. I’ve been binging your content the past couple of days.
Just connected with you in LinkedIn.
I’m a physical therapist and I’m currently exploring the insurance consulting space for my next career move - trying to move more upstream in the healthcare solutions arena.