"To control costs, nearly all health insurers use a system called prior authorization, which requires patients or their providers to seek approval before they can get certain procedures, tests, and prescriptions. Denials can be appealed, but nearly half of insured adults who received a prior authorization denial in the past two years reported the appeals process was either somewhat or very difficult,"
"It's overwhelming by design, because insurers know confusion and fatigue cause people to give up, Nix said. That's exactly what they want you to do. The good news is you don't have to be an insurance expert to get results, she said. You just need to know how to push back."
Prior authorization is a common insurer cost-control system that requires approval before many procedures, tests, and prescriptions. Patients often face denials that can be appealed, but nearly half of insured adults who received denials reported the appeals process was somewhat or very difficult. Patients can increase approval chances by knowing their insurance type and applicable rules, collecting and submitting detailed medical records, and asking providers to make direct case arguments or peer-to-peer calls. Timely appeals, external reviews, complaints to state regulators, careful documentation of conversations, and persistence or switching insurers can overturn denials and secure recommended care.
Read at www.sandiegouniontribune.com
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