Elite's Medical Secret to Get Approved 99% of The Time

Elite's Medical Secret to Get Approved 99% of The Time

If one's doctor orders a test or treatment and the insurance company denies it, here is what to do:
  1. Call the insurance company and tell them, by federal law, they must allow one to speak with the "HIPAA Compliance/Privacy Officer" (by federal law they must have one).
  2. Ask them to supply the NAMES + CREDENTIALS of every person accessing one's records in order to make that decision of a 'denial', as required by federal law.
  3. They will almost always reverse the decision very shortly after that request versus admitting that the committee is made of minimum-wage high school graduates and GEDs that are merely looking for "criteria words" before deciding to deny care. Even in the extremely rare case the decision was made by medical personnel, it is unlikely that it is made by a Board Certified Doctor in that specialty and they do not want anyone to know this!
  4. Any refusal can be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation, and a lawsuit may be filed as well for 7x whatever all testing + procedures would cost (get estimate from hospital and let them know they can hyper-inflate the bill - like they normally do!).
NOTE: One can re-submit a denied or rejected health insurance claim, usually within a 30 to 180-day window, this will turn even valid denials into potential approvals by repeating the above-process.