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- Sep 19, 2021
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Interesting. Do the CEOs actually get involved in denials? I used to work for physicians at a level 1 trauma center and we had to get peer to peer reviews all the time. I have never had one go to the CEO. It was always MDs doing the reviews and talking to the treating physicians. They were the step above the nurses who did the second denial after it was denied by the lay people working for the insurance. We always had the different company policies for every procedure on hand prior to trying to get things approved. It was a lot of time and work in many cases. But i never had any go to the CEO who isn’t usually medically trained. Many of the denial policies have been in place for a very long time. They never take into consideration that every patient is different and medicine isn’t exact and can vary by patient. They have checklists they follow and do not deviate.
I’m sure CEOs, if they cared to do so, could exert some influence over denial policies.