Realize that your policy, carried out constructively, can encourage partnering. Remember to keep the patient involved throughout the appeal process. Often, physicians and staff avoid directly involving the patient because such involvement can be cumbersome. Don't lose sight of the fact, though, that an insurance policy is an agreement between the insurer and patient, and it is the patient who pays for insurance coverage both indirectly and directly and who consumes the service. There's another crucial reason to involve the patient in the process.
Appeals are much more successful when initiated by beneficiaries.
Take the case of one patient who submitted a request for reconsideration and recovered full benefits. On her own initiative, the patient contacted four other physicians in the area asking for fees for an uneventful pregnancy with a normal delivery. In her correspondence to the insurance company, the patient delineated her findings and asked for reconsideration. She even offered to change physicians if the plan could locate one who would deliver a baby for the company's UCR amount. The insurer responded by paying for the services in full.