How We Help Your Practice
It is an unfortunate reality that all medical specialties face unrelenting demands from insurance payers and administrators simply to get patients authorized for treatment. Time-consuming benefit verification and prior authorization processes delay access to care, which frequently results in serious adverse effects for patients.
Even when your office does everything according to an insurance company’s requirements, those efforts are frequently met with denials, which are devastating both to patients who need insurance coverage confirmed before they can begin treatment, and healthcare providers who now must determine if they have the time and expertise needed to help the patient through the complex and time-consuming process of appealing that denial.
PRIA Appeals provides an ideal resource to busy healthcare professionals who know a patient’s best chance to get a denial overturned is to refer them for an unbiased and comprehensive review of the denial by expert advocates with an established record of success.
At PRIA Appeals, we have more than 25 years of experience navigating the medical appeal process, and can save your busy medical practice from having to:
- Determine why an insurance company denied a treatment or procedure
- Learn strategies for overturning denials based on:
- Lack of medical necessity
- Contract limitations or exclusions
- Experimental or investigational device or treatment plan
- Learn each payer’s appeal process, because no two plans handle them exactly alike
- Obtain additional supporting documentation and medical records for the appeal in order to overcome the objection(s) voiced by the insurer
- Spend hours on the telephone trying to get insurers to confirm the status of the appeal
- Verify that insurers are following all the rules required to protect a patient’s rights
- Continue to help patients who receive a final adverse decision by seeking out an independent, external review of the insurance plan’s decision
Knowing your patient has expert help getting approved, at no cost to the practice, provides peace of mind and frees up staff and resources that would otherwise be involved with appeal. If you have patients who have been denied coverage, refer them to PRIA Appeals today!