So, you’ve filed a claim—but then what? Where does it go and what happens next? Insurance companies don’t always share what happens behind the scenes, so in the spirit of transparency we're re-sharing this information for anyone that needs a refresher. Below, we walk you through each step at how the average claim gets processed.
Topics: Claims
Last week, Dr. Lisa M. Scarfo, MD—Pediatrician and Medical Director at AllWays Health Partners, talked with us about bridging the gap between doctors and health insurance providers regarding the medical necessity process. She continues the conversation with how medical necessity can speed up prior authorization determinations. If you missed the first part, click here.
Otherwise, you can read part 2 of the two-part series below to learn about common misconceptions and some tips providers can benefit from and start using today.
Topics: Claims, Medical leadership partners
Dr. Lisa M. Scarfo, MD—Pediatrician and Medical Director at AllWays Health Partners, talked with us about bridging the gap between doctors and health insurance providers regarding the medical necessity process. Read on for part 1 of a two-part series to learn about common misconceptions and some tips providers can benefit from and start using today.
Topics: Claims, Medical leadership partners
When you file a claim, what happens to it? The answer may be more complicated than you think.
| UPDATE: Federal law is beginning to move towards a solution to high prescription drug prices. The U.S. Supreme Court will soon take up a case on whether states can regulate certain aspects of prescription drug reimbursement, essentially taking on pharmacy benefit managers (PBMs) and protecting pharmacies from below-cost reimbursements. In addition, the “Lower Costs, More Cures Act” was introduced in December with the aim to lower out-of-pocket spending, protect access to new medicines, and strengthen transparency, accountability, and competition. This act has considerable bipartisan support, making it likely to pass. Today's post is from our broker blog, AllWays Insider, which is exploring pharmacy cost trends in a series of posts. Because many of the dollar amounts reported on cost increases are so staggering, health plans and pharmacy benefit managers (PBMs) are working together to address increasing drug costs. Here are four measures aimed to control premium and out-of-pocket insurance costs and help manage prescription drug costs. |
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