What Your Medical Review Companies Role?
A medical review company supplies more than a second opinion. The impartial nature of a medical review company is essential not only to the bottom dollar, but to the final result. Too frequently, patients think they are just numbers in a file or little bits of information in a computer program. The tainted image of an insurance company's automatic rejection of claims without truly keeping in mind the patient's need contributes consumer discontentment and frustration.
What Does It Have to Do With You?
Patients are people and when they require healthcare, they don't want to read a medical dictionary or the fine print, they just want their claims covered. Usually, it's not likely they would realize that their insurance claim went through an Insurance Review Organization's medical insurance review procedure. They probably just fill out the forms, give a receptionist their insurance card and sign on the required release forms.
One of the most standard complaints about needing healthcare is the fee followed closely by the complications of paperwork created through authorization forms, claim forms and more. An insurance review organization is an intermediary company that insurance companies may contract out their claims to so as to determine with medical and insurance coverage accuracy the credibility of a claim filed by somebody insured by their company.
Insurance providers who deny a claim are often portrayed as heartless or more interested in the bottom dollar than they are about showing compassion. When an insurance company refuses a claim for anecdotal evidence, this perception is only enhanced. When a claim passes through a medical review company's insurance review process-- it will not be rejected or denied based on anecdotal evidence.
For example, a patient experiences shoulder, back and neck pain as well as bra strap grooving and eczema. Her online electronic medical records history indicates years of chiropractic treatment and also advice for non-steroidal anti-inflammatory drugs (i.e. Tylenol, Advil) and worn special support bras to support a 34DD frame and all of it to no success. Overly big busts can cause most of the symptoms the woman's medical history indicated.
The doctor recommended a breast reduction operation to minimize the issue and the symptoms.
When the claim is handed in to the insurance company, the policy may not cover aesthetic cosmetic procedures. Many policies do not. Claim managers lacking medical expertise will often compare a procedure request against a list of approved procedures. If cosmetic procedures are not covered, it is likely the claim will be rejected. The patient is left either opting to pay for the procedure out of pocket or continuing to suffer.
The medical review company has access to a a great deal of medical specialist and insurance experts. The medical specialists will evaluate the patient's medical history and the doctor's suggestions.
If the medical specialist agrees with the patient's physician that she is suffering from Macromastia (excessively large breasts), then he or she will understand that the cosmetic surgery of breast reduction provides the patient with the best option for the patient's relief.
The review process may be transparent to patients whose insurance company uses a medical review company; but the effect is profound. Their medical needs will be taken care of. When it comes right down to it, a medical review company gives patients confidence that both their medical and insurance needs will be fulfilled.