Exclusions within the contract language are often the most frustrating type of denial faced by a patient seeking insurance approval. Thoughts such as “How can they not cover this surgery if my doctors all say it is medically necessary?” run through your head. Those are not unreasonable thoughts. Unfortunately, too many patients simply walk away from even trying to get approved because they think “It isn’t worth it” or “I don’t stand a chance. “NOT TRUE!
CALL US TO DISCUSS THE EXCLUSION YOU HAVE
We will tell you if we don’t think you should get us involved or why we won’t take on a particular exclusion. BUT there are a great many occasions where we can fight those fights and WIN those fights for the courageous patient who refuses to take “NO” for an answer.
Victories over exclusions can be achieved for various reasons such as poor drafting of the exclusion or the company’s failures to follow certain regulations, just to name a couple. However no fight can even start unless you and your surgeon’s office work together to submit the pre-authorization request so you can at least get the insurance company to deny you in writing. That written denial triggers your right to appeal and is what’s needed to start the FIGHT.