TAKE ACTION: Retroactive Denials

PSCF Taking Action to Protect Physicians from Retroactive Denials

We Need Your Help Documenting the Impact of these Practices

The Physicians Society of Central Florida (PSCF) supports legislation being filed in Tallahassee that ensures timely and appropriate care without the fear of retroactive denials, which can delay necessary treatments and negatively impact patient health.  Retroactive denials occur when a physician receives authorization from an insurance company to render a service to a patient, only to have that service denied after the service has been rendered.

The Florida Legislature fixed this issue last year for Dentists (Section 627.6131, Florida Statutes) by requiring insurance companies to be transparent if a patient is delinquent on their insurance premiums, the so called “grace period”.   Furthermore, it holds them accountable for providing reliable information for physicians to act upon.  These protections promote fairness and transparency, and prevents physicians and hospitals from carrying avoidable debt.

The Impact is Real

According to a study conducted by Premier:

• Nearly 15 percent of all claims submitted to private payers for reimbursement are initially denied, including many that were pre-approved to move forward through the prior authorization process.
• Denied claims tended to be more prevalent for higher-cost treatments, with the average denial pegged to charges of $14,000 and up.
• Over half (54.3%) of denials by private payers were ultimately overturned and the claims paid, but only after multiple, costly rounds of provider appeals.
• The average cost incurred by providers fighting denials is $43.84 per claim – meaning that providers spend $19.7 billion a year just to adjudicate with payers.

https://premierinc.com/newsroom/blog/trend-alert-private-payers-retain-profits-by-refusing-or-delaying-legitimate-medical-claims

Take Action to Help Us in this Fight

If you have been impacted by a retroactive denial, please complete this short submission form below to share your story and provide documentation we can use in this fight.  

TAKE ACTION NOW!

https://form.jotform.com/250364860426053