KS HMO Appeal – No Authorization for ER Services and Care
October 12, 2021 9:58 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance... View more
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KS HMO Appeal – Interest Owed on Late Claims
October 12, 2021 9:27 pmURGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Kansas... View more
KS HMO Appeal – Non-urgent Authorization Timeframes
October 12, 2021 8:46 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Kansas Insurance... View more
NJ HMO Appeal – Notice Requirements for Adverse Determinations
October 12, 2021 1:04 pmIMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the New Jersey... View more
MO HMO Script – Refund Recoupment
October 12, 2021 12:09 pmASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
OH HMO Script – Non-urgent Authorization Timeframes
October 12, 2021 11:39 amASK YOURSELF: What date was the request for non-urgent authorization made? Was there any written communication (request for information, denial,... View more
OH HMO Script – No Authorization for ER Services and Care
October 12, 2021 11:38 amASK YOURSELF: What was the patient’s presenting symptoms or chief complaint in the emergency room? Did the plan pay for... View more
PA HMO Script – Untimely Payment
October 12, 2021 11:37 amASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
PA HMO Script – Refund Recoupment
October 12, 2021 11:36 amASK YOURSELF: How many days after payment, did the HMO plan request the refund? Why did the plan request the... View more
NV HMO Script – Maternity Coverage
October 12, 2021 11:33 amASK YOURSELF: Did we verify eligibility? IF SO, WHAT DATE? Did the plan make negligent misrepresentation of the patient’s eligibility?... View more