Re: Coming changes comments

[Guest guest]

> 1. Could patients take over the insurance aspect and deal with the

> hassles themselves. Once your office received my denial, the ball

> was in my court and I have had to run with it. What else could

> patients do to help their own cause. Are the problems with insurance

> after approval?

>

> 2. Would you consider eliminating clinics for a few months. You

> could stop accepting new insurance patients and only accept self pay.

> You could weed out the less serious patients in the database and let

> the serious ones proceed.

>

Any comments?

RR

Sounds good to me. If they are determined to have the surgery they will

fight for their rights. If you can just give them the tools! I would

think by now that most of the appeals should get the same basic info sent

out. If you could provide patients with a few appeal letters on the

website that they can copy and reword to fit their needs, this should help

a lot. A lot of patients have the same co-morbidities so the fights and

arguments should be pretty much the same. Yes??? No???

Hugs,

Pat Lyle

[Guest guest]

Pat Lyle wrote:

>

>

> Sounds good to me. If they are determined to have the surgery they

> will fight for their rights. If you can just give them the tools! I

> would think by now that most of the appeals should get the same basic info

> sent out.

One of the problems I have found in working with people to get insurance

approval is that the appeals are definitely *not* the same, but sending

the same appeal letter often results in a circle effect of sending in

the wrong thing, getting denied, doing it over again (and over, and

over).

What seems to be missing is someone to look at the denial, find out what

is needed, then individually address *that* issue and no other.

The appeal letter Dr. R. has on his page may work for many people, in a

case where the insurance company has simply issued a " standard denial "

without a solid basis for it.

But if the insurance company has criteria that requires you to prove

that the surgery is medically necessary *FOR YOU* then, each

individual's proof will be different, and each person will also have to

meet *every* criteria that the insurance company requires to prove

medical necessity (and each insurance company has it's own little quirks

and requirements).

And when the person doesn't send in the necessary material, what is

missing can be different for each person. It may be something no more

complicated than sending in a copy of a recent physical exam -- no big

appeal or long letter or anything at all is needed. Just send the

missing piece and bingo, you qualify.

I've seen a lot of people churning their wheels because they didn't know

what the insurance company wanted and didn't know how to find out, but

they pour their hearts out in a letter, saying why they need and want

this surgery -- when all the insurance company wants may be a recent pap

test, or a psych clearance, or some other simple missing piece.

Anyway, all that is to say that each case really is different, once it

has been denied.

Hope that makes sense.

Kind regards,

If you could provide patients with a few appeal letters on the

> website that they can copy and reword to fit their needs, this should

> help

> a lot. A lot of patients have the same co-morbidities so the fights

> and

> arguments should be pretty much the same. Yes??? No???

>

> Hugs,

> Pat Lyle

>

> ----------------------------------------------------------------------

> [We help you find the products you'll love]

> ----------------------------------------------------------------------

> This message is from the Mini-Gastric Bypass Mailing List at

> Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> To Unsubscribe Send and Email to:

> MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

Dr. Rutledge,

I have an idea. I was wondering since the heavy workload is on insurance

approvals, why don't you do as someone suggested and charge a certain amount

for the insurance approvals. Then send them to a separate insurance billing

facility. There is a group called RITEWEIGH in Ky, Tn, ETC.. That does

nothing but insurance and schedules appointments. They are paid solely on

the insurance approval and is a separate company. I am not for sure but I

thought that they had clients in North Carolina. That way all your office

has to deal with is mostly getting the bill ready. Just a thought. Keeley