Dig Into Healthcare - Trainings

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Sara's mission is to improve the availability and reimbursement of mental and behavioral healthcare for everyone.  Utilization review may happen at any time, yes even for pre-authorized claims!   The relationships between Provider, health plan and Consumer are not without their conflicts.  The amount of help you give consumers will vary depending on your network status. With out-of-network consumers, it requires a great deal of goodwill and credit certainty to delay collection of payment, or to run a case to external review.   Establishing clinical necessity in insurance appeals often requires an effective partnership between Provider and Consumer.   Ultimately, the health plan benefits vest in the Consumer and it is they who have the ultimate rights of appeal.   Whether you use a billing company or not, your staff need to know about plan types, plan regulation and avenues of appeal, so they can pass this information to the consumers you serve.  This is an added value to Consumers, but it also takes the pressure off billing departments who by definition are the first port of call when claims stop getting paid.  

Mental health parity protections are extensive but the rules are extremely complicated.  Even knowing some of the "red flags" on claim denials and during peer reviews can empower you and your clients to ensure the health plan meets their obligations.

Sara's trainings are available on a list of key topics, focusing on consumer regulation and relationship strategy,  and you may suggest any areas that would bring value to your organization.