(Snippets from the frontline)
You suddenly become ill. The emergency room doctor feels admission is necessary. Your physician agrees, so you are hospitalized with IVs and testing done. Treatment is given, you survive and go home.
Your insurance company denies payment and claims you should not have been admitted. Now you are responsible for all medical bills.
Denial by insurance companies after hospitalization happens more frequently each day. Occasionally, your physician can have a “Peer-to-Peer” phone discussion with the insurance doctor to mitigate the issue.
Here’s the rub: They decide on an “approximate” call time (e.g. 8-12 noon), and expect your physician to be around a computer to reference the medical chart. If this contact is not made within a certain number of days from discharge (sometimes as little as three), their denial automatically becomes irreversible.
Trying to allot “Peer-to-Peer” time is like waiting for cable TV repair. Your doctor is under the gun and gets blamed. Worse, it is time infringement on medical care rendered to other patients.
It’s a new twist in their old game.
Another reason for eliminating insurance company middlemen.
Gene Uzawa Dorio, M.D.