One New York City doctor shares valuable insights on how to handle health insurance companies without going to extreme measures. In the wake of the tragic shooting of a healthcare CEO, Dr. Dan Ginader emphasizes the importance of patient advocacy and provides practical ways to appeal claim denials.

Empowering Patients to Navigate Health Insurance

Use AI against them

ProPublica's report last year exposed health insurer Cigna's use of an automated algorithm that denied over 300,000 payment requests in just 1.2 seconds per case. This led to lawsuits against similar software used by other insurers like UnitedHealthcare and Humana. Dr. Ginader explains that most people don't know they have the right to appeal denied claims. Software companies like Claimable and Anamoly are now using AI to analyze data and help both payers and providers. Claimable claims an 80% success rate in overturning unjust denials within 10 days or less. Anamoly was specifically built for healthcare providers to predict insurance coverage. Its CEO, Mike Desjadon, sat down with NBC 4 Washington to explain how his company streamlines the process.

Request a peer-to-peer review

This involves getting a healthcare provider like Dr. Ginader on the phone with a human at the insurance company to discuss a patient's care. It's typically used for prior authorization approval but can also be for appeal purposes. However, the American Medical Association warns that while it can be helpful, it can also delay serious care. An AMA survey found that 24% of physicians report prior authorization led to a serious adverse event for a patient, and 94% say it increases physician burnout.

Hire an insurance lawyer

The appeal process can be complex and time-consuming, and an attorney can relieve some of the stress. Dr. Ginader has had patients resort to hiring an insurance lawyer, and they've made a difference. You can often get a consultation for a low or even no cost by using local services.

Request a fair hearing

New Yorkers pay some of the highest health insurance premiums, but the state offers social services to help. Those with public health insurance can request a fair hearing with the New York State Office of Temporary and Disability Assistance and have an administrative law judge review their case. Medicare allows you to appoint a representative like an attorney or a friend to handle the appeal. Medicare recipients also get help from the State Health Insurance Assistance Program, and every state has a Consumer Assistance Program that offers free services. In New York, the Community Service Society continues this service, and you can call 1-888-614-5400.