According to statistics released by The Department of Labor, it is estimated that every year about 1.4 billion claims are filed with the employer-based health insurance plans the department oversees. Of those, 100 million are initially denied upon submission. In easier to understand statistics, that is one in every 14 claims. —
This came as no surprise to Dr. Vivek Agrawal MD of The Shoulder Center in Carmel, Indiana. Says Dr. Agrawal, "We hear stories like this all the time from patients of ours. Innovative cutting edge shoulder repair techniques are routinely denied by insurance companies even though it saves the patient, the company and society lots of money and time lost. Additionally, it also saves the headaches of failed surgeries and recovery time for the patient, not to mention the money wasted on the procedure."
Instead, Dr. Agrawal advises patients facing rotator cuff pain who've had their procedures denied to fight back. Says Dr. Agrawal, "Just as you might get a second opinion about a medical diagnosis, you should get a second or even third opinion about your treatment denial. Fight your rejection." With most health insurance policies, an appeals process is in place for a patient to appeal what they feel is an unjust denial, but the consumer has to be prepared to do their research. Experts advise about one half of all appeals taken before the board of appeals result in successful reversals, according to evidence from patient advocacy groups and data submitted from individual states.
However, Dr. Agrawal instructs his patients to be prepared. "Know what your policy states ahead of time and know what your deadline is for the appeal. Additionally, do your homework on the types of treatments available for your injury. For example, you may read up on procedures at our sites and make copies to submit with your paperwork or watch rotator cuff videos describing special procedures, taking notes as you watch. This will give you the insight you need to make a case for the review board."
About The Shoulder Center:
The Shoulder Center is run by Director Dr. Vivek Agrawal MD. Dr. Agrawal attended the University of Illinois for his undergraduate studies and completed his residency in Orthopedic Surgery at Indiana University. Additionally, Dr. Agrawal served as a Major in the United States Air Force. Today, Dr. Agrawal is one of just a handful of surgeons in the United States with expertise performing Reverse Shoulder Replacement and is among less than one percent of American surgeons skilled at using arthroscopic techniques to repair even the most complex and large tears in the shoulder.
Name: Dr. Vivek Agrawal MD
Email: Send Email
Organization: The Shoulder Center
Release ID: 15662