Health Insurance Medical Policy Explained

[@johnt608]

Dr., Thank you for all of your videos! So helpful. Would you ever consider doing a separate video on encounter data submission for capitated providers participating in managed care plans? Maybe compare and contrast to claims data submission? I can generally sort out claims data, but encounter data is beyond my current bandwidth no matter how much I read. Apparently, it's an issue in certain states, and it's incredibly important to get right. Thank you again.

[@ahealthcarez]

Thank you for watching and for your suggestion.

[@robinson2589]

Very helpful!

[@ahealthcarez]

Thank you for watching.

[@DeepakKumar-sw5fg]

Your videos are very helpful😊

[@ahealthcarez]

Thank you for your feedback.

[@wisamyounis1357]

Nice explanation of what is medical policy vs prior authorization. I disagree with the sentiment that doctors including specialists have good reason for over prescribing, testing, treating. There is a place for appeal for members for unusual circumstances as medical policy is not intended to address every scenario, but we have to remember the fact that the US spends more $ on healthcare than any other high income nation, but does not have better quality of life than these countries - it is because there is overuse of imaging, treatments, etc in this country that is not supported by evidence to provide higher quality outcomes.

[@ahealthcarez]

Thank you for watching and sharing your opinion

[@jmensah07]

Excellent video... Often times I have had patients become mad at me because of denial of TMS or their medication and it is the insurance company . . . not me

[@ahealthcarez]

Thank you for watching and for your feedback.

[@free9g]

Can you go over the most popular health insurance in NYC

[@ahealthcarez]

Thank you for your suggestion.

[@smehrabi]

I think when you request a prior authorization, your request will be denied or approved based on coverage/medical policy so i think anything that is mentioned in medical policy requires prior authorization , is that assumption correct ?

[@ahealthcarez]

I would put prior authorization in a separate category. Medical Policy states medical care that will not be covered regardless of any prior authorization… e.g. a certain number of pre-natal ultrasounds. Thank you for watching.

[@liberoAquila]

In European countries I think 2 ultrasounds per pregnancy is standard

[@ahealthcarez]

Thank you for sharing.

[@free9g]

Can you go over medicaid vs. medicare

[@ahealthcarez]

Yes. Already have a video on it: kzbin.info/www/bejne/naq3l2Cvr8aprLs