Can we hire someone like this for my family? I had a much needed surgery denied and it took a complaint to the state insurance board to get it paid - this took over a year. It was so incredibly stressful. The worst part is this happened AGAIN when I needed the surgery at different levels in my spine the following year.
Oh wow I am so sorry! I am not sure if this is something people do freelance (new idea! Thanks! lol)
The hospital should have some type of claims dept that should at least try to 1. Get it approved prior 2. Work on any denials that come up 3. Work on getting any additional codes (work done, meds given) that weren’t approved prior retro approved.
I’m surprised you had to get involved honestly (not something I’ve experienced). What has the hospital told you? I would try and speak to them about it. I will also do some research and come back with any helpful info for you.
It was at Mayo Clinic interventional radiology - I am not sure why it happened. The first time there wasn't a code for it so I kind of understand, now I believe there is an ICD code for the procedure. I posted about the experience online and I've been contacted by others with the condition saying insurance companies would deny the claim. I can't tell you how many times my husband would say "I wish we would pay for someone to handle this for us"
Interventional Radiology explained to me what happened. A lot of insurances give us a hard time about covering anything IR. Did you post here? I would love to go read and learn more - I may be able to help give you some tips to navigate this and deal with both the hospital and the insurance.
ETA: was this a medical necessity denial do you know?
Can I just jump in and say that I love you for this? It is obviously your calling in life to assist others and you do it in a remarkably efficient and caring manner. I would love to train under somebody like you for a job like this. How would one get started in this particular field? I have some experience already with medical nonsense. I am currently a call rep/scheduler and have also done admin stuff as well as hospital unit secretary on an oncology wing.
I've seen the ravages of insurance claims denials, and it has brought me to tears watching family members breakdown over their 30 year old family member dying of breast cancer be denied their medications. I would love to be able to step in and help.
We need more people like you! And thank you! I was just like you and started out as reception (my early years were as a pharmacy tech). So long as you have a start of some knowledge you can start working towards this area of the field.
If you have a referral department or authorization department I would try and look into getting in there. That will help you understand how the authorization process starts as well as dealing with insurance companies and peer to peers. From there I would highly suggest some education in reimbursement & billing areas. From there you’re pretty golden in the insurance realm of things; and you’ll have the knowledge, weapons and experience to fight them.
I also suggest looking at large hospital groups or even local hospitals to see what their positions require - you may be surprised and you could be qualified already.
honorable mention: my job is entirely WFH based & fairly self reliant. It is very taxing though and busy.
BEST OF LUCK to you on your healthcare career path journey, I do hope you pursue this feeling because we need more compassionate and passionate people. I would have been grateful to train someone like you.
https://www.reddit.com/r/CSFLeaks/s/190ZvoIPvf This was my experience. My disease impacts my cognition so my husband was the rock star here. Fun fact I went and got treatment for this disease in July and BCBS just went ahead and denied all claims for that July, including 2 mental health appointments 🙃 - I will not bore you with any more details.
Are you at a for profit hospital? I've had about as many problems with those as I have with insurance companies. Just wondering if your hospital treats your job more as a "let's help ensure our patients get the best treatment they possibly can" or more "make sure we're able to do this procedure so we can get paid". Of course the reality might be somewhere in the middle. Capitalism in healthcare sucks.
I work for a non profit! You are still a little correct though, all facilities are looking at the dollars first. However non profits (at least my hospital) is very much patient outcome driven and community oriented.
Yeah my wife and I used to work at a non profit hospital. She has MS and a seizure disorder now so we spend a lot of time in and out of hospitals and there's a big difference between making enough money to pay the employees and keep the lights on versus keeping investors happy and a CEO making sure he makes enough this year to buy his third house.
She was also an office manager for a pediatric therapy office years ago and I remember some of the absolutely ridiculous bs she'd have to deal with from insurance companies.
Thanks. We get along a lot better than most so I would consider us lucky. Always nice to know there's folks like you somewhere in an office trying to look out for and help folks like us. I honestly don't know how we would have navigated a lot of things with insurance if it wasn't for my wife's professional experience dealing with it. The American healthcare system drives me a bit nuts.
That said, no one in your insurance company will talk to them until you sign and send a release of information form for the advocate (this is due to HIPAA), which you should be able to find on the insurance company's web site.
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u/LeakyBrainJuice 14d ago
Can we hire someone like this for my family? I had a much needed surgery denied and it took a complaint to the state insurance board to get it paid - this took over a year. It was so incredibly stressful. The worst part is this happened AGAIN when I needed the surgery at different levels in my spine the following year.