6 Video Lessons
Treatment Exclusions and Limitations have a direct impact on provider reimbursement. Unfortunately, denials related to policy or plan exclusions and limitations are often not appealed because providers do not have sufficient information regarding the policy or plan terms. We provide information on how to approach these types of appeals under the following Treatment Exclusions and Limitations Topic Pages.
Lesson 1: Coverage Termination
Consolidated Omnibus Budget Reconciliation Act (COBRA) gives certain workers the right to continue group health benefits through a previous ...
Lesson 2: Experimental Treatment Appeals
Access to new drugs, procedures and equipment is one of the most challenging aspects of healthcare delivery. Patient are rarely in a positio...
Lesson 3: Maximum Benefit Appeals
An effective maximum benefit appeal should demand an audit of benefits released to date. The purpose of the appeal is to determine to dollar...
Lesson 4: Preexisting Conditions
Preexisting decisions rest of determining the onset of a medical conditions. See our letters which can assist with appeals meant to clarify ...
Lesson 5: Timely Filing Limitations
A successful timely filing appeal often involves submitting proof of timely filing. Read how to use an affidavit to strengthen your timely f...
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President of Appeal Solutions, Tammy Tipton is an author and frequent speaker and expert on resolving denied and disputed medical insurance claims.
What You'll Learn:
- Coverage Termination
- Experimental Treatment Appeals
- Maximum Benefit Appeals
- Preexisting Conditions
- Timely Filing Limitations
- Treatment Caps
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