Want Change? Work Together 🔁<p><span class="h-card"><a href="https://mastodon.scot/@bodhipaksa" class="u-url mention" rel="nofollow noopener noreferrer" target="_blank">@<span>bodhipaksa</span></a></span> <br><a href="https://qoto.org/tags/Insurance" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>Insurance</span></a> <a href="https://qoto.org/tags/advice" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>advice</span></a><br>📋 Text version, not just Alt text...</p><p>To everyone in a similar scenario: the tactic my doctor's office has taught me is to ask, in writing, for:</p><p>1) the name, board specialty, and license number of the <a href="https://qoto.org/tags/doctor" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>doctor</span></a> making the determination the <a href="https://qoto.org/tags/treatment" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>treatment</span></a> was not <a href="https://qoto.org/tags/medically" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>medically</span></a> necessary;</p><p>2) copies of all materials they relied on to make their determination;</p><p>3) proof the doctor making the determination has maintained registration in your specific state and <a href="https://qoto.org/tags/documentation" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>documentation</span></a> of their meeting all their continuing <a href="https://qoto.org/tags/education" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>education</span></a> <a href="https://qoto.org/tags/requirements" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>requirements</span></a>;</p><p>4) the aggregate rate at which similar treatments are denied vs approved by the specific doctor being used for peer review.You are not entitled by <a href="https://qoto.org/tags/law" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>law</span></a> to *all* of these things in most <a href="https://qoto.org/tags/states" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>states</span></a>, but you're entitled to some of them, and you can always ask for them.</p><p>This is, she says, a wildly successful tactic, because if the insurance c#ompany answers them honestly, it gives you <a href="https://qoto.org/tags/evidence" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>evidence</span></a> that the"doctors" making these determinations are practicing <a href="https://qoto.org/tags/medicine" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>medicine</span></a> out of scope, without proper <a href="https://qoto.org/tags/licensing" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>licensing</span></a> and <a href="https://qoto.org/tags/qualifications" class="mention hashtag" rel="nofollow noopener noreferrer" target="_blank">#<span>qualifications</span></a>, in areas they are not competent in.</p><p>Everyone knows this is true; it's not a secret in any way. But it's in violation of a number of regulations, and a LOT of times the company will just give up and pay the bill rather than handing you proof they're violating the regs. It's a tactic that has worked for me many, many times.</p><p>rahaeli on Bluesky posts the above.</p>