Denials of care are getting more common. Suppose you hear about a new treatment and your doctor agrees to try it. But, your Medicare Advantage insure will not cover the care. What do you do?
As I have written before the patient needs a patient advocate to get good care. A recent article in Forbes again proves the point. The Aetna Medical Director admitted in a lawsuit that he did not review denials of care. Nurses reviewed the files and made the decisions. The case in point involved a rare condition that the doctor did not know the treatment protocols and did not review the patient’s medical record before denying care. Obviously the nurses did not either and the treatment was denied over the patient’s doctor recommendation. You can read the article here.
The moral is clear. When you receive a denial of care, advocate with your doctor. If your doctor agrees that the denial is wrong go up the appeal ladder with your doctor’s support. Eventually the appeal process requires review with the patient’s doctor and that often results in approval.
