Risk Management Archives – Academic HealthPlans
 

What is Prior-Authorization & Why do Insurance Companies Require it?

Costs and Coverage, International Students, Risk Management, Student Affairs, Student Health

“This procedure/medication will require prior-authorization.” Words that no patient wants to hear when they are ready to proceed with a doctor-approved treatment plan for their medical concerns. However, it is one of the utilization management tools that insurance companies have developed to determine whether certain prescribed procedures, services, and medications are medically necessary, or whether there is an equally effective treatment available to the patient.

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What to do when your insurance claim is denied? A high-level overview of the appeal process.

Costs and Coverage, International Students, Risk Management, Student Affairs, Student Health

Imagine opening your mail to find a surprise bill from a medical provider due to a denied claim. Now imagine that preauthorization for your child’s lifesaving procedure was denied. These are not situations that students, or anyone else, should have to worry about. A denial from the insurance company can be disheartening, but there are steps that can be taken to appeal the decision. Below is a high-level overview of the process for appealing an insurance claim.

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The Top 8 Common Billing Errors

Costs and Coverage, International Students, Risk Management, Student Affairs, Student Health

You’ve worked hard to negotiate competitive health insurance rates and benefits for your students.

You’ve worked relentlessly to educate them on how to use their insurance.

But then an upset student contacts you about an insurance claim they believe is inaccurate, or that they shouldn’t have received at all. It’s a difficult situation for everyone.

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