Wiki Appeal letters for patients

[tomtom2]

Is it ethical to create fill in the blank appeal letter for patients? We will be going out of network with a large payer (because they will not pay) and want to help our patients with thier appeals.

Thanks,

 

[Kiana]

Appeal letters for what? Is it for the patients to fill in the blanks to appeal to the insurance about reconsidering contract between provider and insurance in hopes that the provider remains contracted?

 

[tomtom2]

The appeal letters are for the insurance company to reprocessed the claim under the patient's RAP clause (Radiologist, Anesthesiologist, Pathologist). The patient has to ask the insurance company to do this because the provider can't. The patient also has to put curtain key phrases like (reprocess this claim as I went to a par hospital and had no choice which Dr reviewed my specimen). We will be seeing hundreds of non-par patients weekly and want to keep good pr. Without hundreds of phone calls explaining how to appeal the insurance company's decision not to pay and making it patient responsibility.

 

[KellyCPCCPCO]

Yes, a common template appeal letter for patients to use is fine.

 

[Kiana]

Yes, then a appeal template is perfect.

 

[tomtom2]

Thanks, I'll move forward on our appeal templates.