More than 11% of medical claims are initially denied, according to a 2021 study of 102 million transactions at 1,500 hospitals. The skyrocketing rate of denials – up more than 20% since 2016 – for medically appropriate care has become an increasingly growing problem for patients and doctors, especially when it comes to soft tissue injury healing. “Unfortunately, medical policies are driven by insurance company profits and fear of change,” said
Patients and providers with the best intentions may not follow the proper steps to get their procedures or prescriptions covered, Lewis said. Advocating for clinically effective procedures to be covered starts with communication between three parties — the patient, the healthcare provider, and the insurance companies. If a procedure or medication is not covered by health insurance, most patients and their healthcare providers simply give up. But it is possible to talk to the insurance company and change those decisions.
“The first ‘no’ by an insurance policy can be turned into a ‘yes’ if you are informed and persistent,” Lewis said. “At ZetrOZ, we encourage patients and providers to not simply give up with the first denial of an insurance claim for therapies like Sustained Acoustic Medicine (sam®). Your insurance should always cover treatments that are proven to be both medically effective and cost-effective.”
ZetrOZ’s proprietary sam® technology was funded by federal government grants, built on 46 patents and supported by more than 40 peer-reviewed medical studies and successful treatment of millions of patients nationwide. Recent level 1 studies, the highest level of clinical evidence, demonstrates the clinical and cost-effectiveness of sam® for treating soft-tissue musculoskeletal injuries. sam® has a demonstrated cost savings on the healthcare system worth millions of dollars each year in
Despite that success, however, sam® is often not covered as a first-line treatment by insurance plans. This stems from patients, providers and insurers having fragmented information on the cost and quality of care, Lewis said, and leads to denials of health insurance claims which would actually reduce healthcare expenditure.
The most effective step for a patient to avoid the first denial of health insurance benefits coverage is to have a conversation with their healthcare provider and their insurance representative within the practice. After researching treatment options, you have a better chance of physicians ordering the procedure or prescription correctly in order to meet the insurance claim adjusters’ criteria.
Although this process is not always straightforward, the decision can still be appealed if a denial letter of coverage is received from your healthcare benefits. It may be a paperwork issue, an incorrectly entered billing code, a tax ID placed into the wrong box, or coding the procedure or prescription in another way that could help with getting the appeal approved.
The reality is that millions of Americans are impacted by the coverage gap and spend hundreds, or even thousands of dollars out-of-pocket on health care costs. ZetrOZ believes that when a patient is in pain, nothing should stand in the way of receiving the care they need. ZetrOZ helps patients achieve optimal soft-tissue healing and prevent future surgeries and long-term disability by helping people heal faster.
If you are struggling with receiving treatment or a solution to healing an injury or pain, speak to your physician and learn more about ZetrOZ | https://zetroz.com.
About ZetrOZ Systems
ZetrOZ Systems is an FDA cGMP and ISO 13585 medical technology company headquartered in the southern coastal region of
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Source: ZetrOZ Systems