“This procedure/medication will require prior-authorization.” Words that no patient wants to hear when they are ready to proceed with a doctor-approved treatment plan for their medical concerns. However, it is one of the utilization management tools that insurance companies have developed to determine whether certain prescribed procedures, services, and medications are medically necessary, or whether there is an equally effective treatment available to the patient.
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Imagine opening your mail to find a surprise bill from a medical provider due to a denied insurance claim. Now imagine that preauthorization for your child’s lifesaving procedure was denied. These are not situations that students, or anyone else, should have to worry about. A denial from the insurance company can be disheartening, but there are steps that can be taken to appeal the decision. Below is a high-level overview of the process for appealing an insurance claim.
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In the simplest terms, insurance is protection from a risk in exchange for some form of payment.
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You’ve worked hard to negotiate competitive health insurance rates and benefits for your students.
You’ve worked relentlessly to educate them on how to use their insurance.
But then an upset student contacts you about an insurance claim they believe is inaccurate, or that they shouldn’t have received at all. It’s a difficult situation for everyone.
It’s estimated that about 12.2% of adults living in the United States do not have health insurance. Since there is an estimated 250-million individuals over the age of 18 living in the United States, this roughly equates to over 30 million adults living without health insurance. If you have multiple insurance plans, consider yourself very lucky.
Short-term plans, or limited duration insurance plans have just been amended as of last week.
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