The documentation insurance companies demand includes data about non-surgical treatment — previously compiled by primary care physicians or non-operative specialists — as well as the appropriate diagnostic and imaging studies, or the insurance company will deny the surgery. Other times, surgeons have difficulty pinpointing why payers denied coverage. Denials arrive because not all requirements were met, but the unmet requirements aren’t specified.
Especially with more expensive procedures such as spinal fusions, insurance companies are sending more frequent denials, forcing surgeons to spend time in the appeals process. The process includes a peer-to-peer review, and often the insurance company representative isn’t a spine specialist. Pending continued denial, surgeons complete three or four levels of appeals, which means less time to see new patients.
“In our Reimbursement Management Center, we process prior authorization and claim denials daily for spine surgeons and new technologies,” says Ms. Neumann. “Techniques that work to overcome these roadblocks are time consuming and require extensive knowledge of not only the particular payor policies but process that gets them approved.”
More Articles on Spine Surgery:
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