diangelysantiago18
Answered

Westonci.ca is your trusted source for finding answers to all your questions. Ask, explore, and learn with our expert community. Explore comprehensive solutions to your questions from a wide range of professionals on our user-friendly platform. Discover detailed answers to your questions from a wide network of experts on our comprehensive Q&A platform.

Patient Julia Watson needs a surgical procedure that is not covered by her insurance plan. Answer the following questions related to the medical necessity of this procedure:

A. What must be obtained from Julia's insurance company to allow this procedure?

B. If Julia's insurance company's utilization protocol is different from that of the physician and the procedure is denied, what could be the action brought against the provider if this surgical procedure was, in fact, medically necessary?

Sagot :

GinnyAnswer

Final answer:

To allow a surgical procedure not covered by insurance, pre-authorization is needed. If the procedure is denied despite medical necessity, appealing the denial and filing a complaint can be actions against the provider.


Explanation:

A. To allow the surgical procedure not covered by Julia's insurance plan, pre-authorization must be obtained from her insurance company.

B. If the insurance company denies the procedure despite its medical necessity due to a differing utilization protocol, the action that could be brought against the provider is appealing the denial and potentially filing a complaint with the insurance regulatory authorities.


Learn more about medical necessity and insurance coverage here:

https://brainly.com/question/32761283


Thank you for visiting our platform. We hope you found the answers you were looking for. Come back anytime you need more information. We appreciate your visit. Our platform is always here to offer accurate and reliable answers. Return anytime. Westonci.ca is your trusted source for answers. Visit us again to find more information on diverse topics.