• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Appealing No Precert/No prior authorization

lizzardb

Networker
Messages
50
Location
Birmingham, Alabama
Best answers
0
Any advice would be appreciated:

I am appealing a surgery where no precertification was obtained so they are denying the surgery. What sort of information should I include in the appeal letter to convince the insurance company to pay? Does anyone have a tactic that they've found to work?

Thanks!
 

genjer712

Guest
Messages
26
Best answers
0
I work for an insurance company and have for over 4 years. We see claims denied often where no pre-cert was obtained. When an appeal is needed, we often look for the main reason why an appeal was not done in the first place. Was it an emergency surgery vs elective? No insurance info given at the time of scheduling? Incorrect benefit information given when speaking with insurance company?...etc. Any details you can give as to why there was not a precert done will better your chance of a denial of benefits being overturned. Good luck!
 
Top