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Step-by-step guide explains how to research, write and deliver a winning insurance appeal.
"Laurie Todd is the Insurance Warrior. Diagnosed with appendix cancer, she fought her health insurer's denial of care and won. Since then, she has written appeals for patients all over the country, with many different insurers. She has never lost a case"--P. [4] of cover.
'The Appeal of Insurance is an excellent collection that reflects a growing interest in insurance research within the social sciences. Clearly written and accessible to a variety of audiences, this is a volume of world-class scholarship.'-Luis Lobo-Guerrero, School of Politics, International Relations, and Philosophy, Keele University In the marketing of its products, the insurance industry has always depended on a considerable dose of moral exhortation and enlightened appeal. The Appeal of Insurance traces the ways in which insurance over the past three centuries, perhaps more than any other business, has grown in concert with a clientele largely of its own making. Faced with a public that has preferred to avoid confronting the certainty of fatality or the probabilities of catastrophe, insurance promoters have had to create a demand for their products, first, by persuading the public to see the world as ruled less by divine judgments and more by statistical patterns, and second, by proclaiming a moral imperative of hedging against death and disaster by the prudential recourse to insurance. The essays presented here examine the history of insurance as a process of negotiation between the embedded social, legal, and cultural norms out of which the practice of insurance grew, and the new arrangements and sensibilities that insurance itself helped bring into being. Today, insurance is a global economic colossus and a fixture in the developed countries of the world. But neither the financial clout of the insurance industry nor its ubiquity conveys the full measure of its social and political influence. The insurance industry has in fact become a primary agent of discipline and control over public and private behaviours by imposing upon them the criterion of insurability. By tracing the boundaries of acceptable (and compensated) from unacceptable (and uncompensated) risk, insurers directly or indirectly govern people, products, and markets, and by this process become one of the most powerful and pervasive agents of social and economic control. Geoffrey Clark is a professor in the Department of History at the State University of New York at Potsdam. Gregory Anderson is the former Associate Head of the Business School at the University of Salford. Christian Thomann is a senior fellow at the Centre for Risk and Insurance at Leibniz University, Hanover. J.-Matthias Graf Von Der Schulenburg is the Director of the Centre for Risk and Insurance at Leibniz University, Hanover.
Written by an impressive team of specialist contributors, Insurance Dispute is the authoritative guide to litigation for both the insurer and the insured. Divided into two parts – principles of law and their practical use in individual types of insurance, it aims to identify and resolve questions such as: • How should the claimant handle a dispute? • Is the claim within the cover? • When should an insurer dispute cover? • What steps can an insurer take to deny cover? Updated and revised to include new chapters on marine insurance, the Financial Ombudsman Service and ATE insurance, Insurance Disputes is essential reading for anyone involved in insurance law and litigation.
The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!
Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice
"Ultimate Guide to Dental Billing and Reporting provides a proven, accessible, and easy-to-implement dental billing template for any dental office. All practices will benefit from the simplicity and positivity of this important guide. I really like the actual number examples and the templates for how to structure your day. It's great information and a must-have for all dental offices." -Dr. Christopher Comer, DMD FAGD, Savannah, GA "This book makes billing and insurance very easy to understand. It maps out a very concise approach to insurance and billing in the dental office. I have taken many CE courses on these topics over the years. This book not only gave a more complete picture of the billing and insurance process than I have seen previously but also gave an easy way to approach and implement the process in the dental office." -Dr. Michael Groover, DMD From Chaos and Confusion to Confidence and Cash Flow Making appointments. Filing claims. Answering the phone. Checking patients in and out. If you're an office manager or insurance coordinator, you know how challenging it is to run a dental office. And if you're new to the industry? Welcome - we're here to help you learn the ropes. Here's the truth: Every dental office's success depends on: Healthy production and collections Smooth patient flow Delivering the ultimate patient experience with a smile The lifeblood of any successful practice is a rock-solid dental billing process. This book is a step-by-step guide to a groundbreaking dental billing process written by a leader in the industry. You're about to learn how dental billing impacts the overall health of your practice. You'll finally understand the gems hidden inside your dental reporting and how to use them. Best of all? You'll leave billing chaos behind and take a major step toward healthy cash flow and confident mastery of your processes.