Los Angeles Times Article Featuring Pat Palmer

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The Los Angeles Times has recently published an article featuring Pat Palmer of Medical Billing Advocates of America entitled “When Insurers Don’t Pay for Surgery“, written by Lisa Zamosky.
The article tells the story of a man who was denied payment from his health insurance for a necessary surgery which previously had been approved, but left the man with a hefty hospital bill.latimes

In the article, Palmer advises readers to receive an authorization letter from your doctor and your health insurer before your surgery. In the event that there is a problem with your insurer paying for your procedure, Palmer suggests having your surgeon’s office send a document to your insurance provider which outlines the details of your surgery. Sometimes, this can help increase reimbursement for an underpaid claim or can help overturn a denied claim.

Zamosky explains that the patient featured in this article was denied coverage because his surgeon used an instrument during the surgery that was not approved by the FDA for the purpose for which it was used. Palmer defends the patient, stating that patients are not going to know what type of tools the surgeon will use during a procedure and that the financial burden should be placed on the provider rather than the patient.

According to Palmer, often the insurer has outdated information, stating that the insurer might not be reinvestigating the approval of products, but might be basing their information on old investigations. For instance, a previously non-approved tool could have been approved in the last few months, but an insurer is not going to know that unless they reinvestigate.
Insurer decisions can also be appealed. Palmer suggests patients request a live appeal, rather than a written one. This gives the patient the chance to explain or defend an item when the insurer has a problem with a claim.

When dealing with an insurance company, make sure you have explored every option before accepting what they are willing to pay. Many times, you can walk away with more money in your pocket.

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Pat Palmer
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2 responses to “Los Angeles Times Article Featuring Pat Palmer”

  1. Roger says:

    great read can I share this?

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