Medical Review Companies Role in Your Insurance Claims – Your Health, …

A medical review company supplies more than a second opinion. The objective character of a medical review company is basic not only to the bottom dollar, but to the final consequence. Too often, patients think they are just numbers in a file or bits of information in a computer program. The maligned image of an insurance company’s automatic denial of claims without really understanding the patient’s need contributes consumer dissatisfaction and frustration.

What Does It Have to Do With You?

Patients are people and when they need healthcare, they don’t want to read the fine print or a medical dictionary, they just want their claims covered. Most often, it’s doubtful they would realize that their insurance claim went by an Insurance Review Organization’s medical insurance review course of action. In fact, they probably just fill out the forms, hand a receptionist their insurance card and sign on the necessary release forms.

One of the most shared complaints about needing healthcare is the cost followed closely by the complications of paperwork generated by authorization forms, claim forms and more. An insurance review organization is an intermediary company that insurance companies may outsource their claims to in order to determine with medical and insurance coverage accuracy the validity of a claim filed by someone insured by their company.

Your Health Matters

Insurance companies who deny a claim are often portrayed as heartless or more interested in the bottom dollar than they are about showing compassion. This perception is only augmented when an insurance company rufuses a claim for anecdotal evidence. When a claim goes by a medical review company’s insurance review course of action – it will not be rejected or denied based on anecdotal evidence.

For example, a patient suffers from shoulder, back and neck pain in addition as bra strap grooving and eczema. Her medical history indicates years of chiropractic treatment in addition as advice for non-steroidal anti-inflammatory drugs (i.e. Tylenol, Advil) and worn specialized sustain bras to sustain a 34DD frame and all of it to no success. Excessively large breasts can cause many of the symptoms the woman’s medical history indicated.

The doctor recommended a breast reduction procedure to alleviate the problem and the symptoms.

Your Coverage Matters

When the claim is submitted to the insurance company, the policy may not cover elective cosmetic procedures. Many policies do not. Claim managers lacking medical skill will often compare a procedure request against a list of approved procedures. If cosmetic procedures are not covered, it is likely the claim will be denied. The patient is left either choosing to pay for the procedure out of pocket or continuing to suffer.

If the claim is submitted to a third party intermediary such as a medical review company, the answer will be different. The medical review company has access to a large number of medical specialist and insurance experts. The medical specialists will review the patient’s medical history and the doctor’s recommendations. When her file is reviewed, the third-party specialist will take into account the history of shoulder, neck and back pain. They will observe the visits to a chiropractor and other pertinent symptoms.

If the medical specialist agrees with the patient’s physician that she is experiencing from Macromastia (excessively large breasts), then he or she will understand that the cosmetic surgery of breast reduction provides the patient with the best option for the patient’s relief.

Confidence Matters

The review course of action may be transparent to patients whose insurance company uses a medical review company; but the effect is profound. Their coverage premiums will likely be lower. Their medical needs will be addressed. They will not see their healthcare costs rise due to the underwriting of unnecessary procedures. When it comes right down to it, a medical review company gives patients confidence that both their medical and insurance needs will be met. They won’t have to suffer misery unnecessarily nor confront collections over mounting debt.

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