How Our Justification, Authorization and Billing Team Helps Advocate on Your Behalf
by Amber Henson, on Jan 27, 2020 3:00:00 PM
Can’t stop, won’t stop. That is how our Justification, Authorization and Billing (JAB) Team is best described. This group of tenacious, experienced and caring individuals have a laser-focus on what it takes to get all Arm Dynamics patients exactly what they need to successfully get back to life and work. How does our JAB Team go above and beyond to get necessary prosthetic devices authorized? Read on.
A Tried-And-True Process
Many times, an authorization claim is denied by an insurance carrier when it is first submitted. This is a fairly standard occurrence. These initial setbacks encountered by the patient are sometimes enough to discourage them from appealing. Arm Dynamics is well aware of the likelihood of the first claim being denied – so much so that we have a task force within our JAB Team that specifically addresses appeals. Our Team prepares our patients for a first denial, and if that denial does indeed come, then we move on to the appeals phase and the task force steps in. If the second level appeal is denied, we move on to having an Independent Review Organization (IRO), an outside company, review the case based solely on the facts. Most insurance companies are bound by the results of an IRO, and oftentimes, we can get a case turned around with an IRO.
But even if that doesn’t work, we have options beyond that. And we exhaust all of them.
When you become an Arm Dynamics patient, that means you have some intensely determined individuals on your team. Elisa, in Authorizations, describes herself as “a stubborn person, but only when it comes to pursuing authorizations for our patients.” That's precisely the type of person you want on your side. Always polite, patient when they have to be, but stubborn when it comes to getting you what you need. Lora, in Justification, says, “I get frustrated with the denials, especially when the insurance company gets a detail incorrect. I spend more time researching, trying to find articles and stories of amputees who have experienced the same type of denial to make sure our patient gets what they need.” Lora mentions another helpful aspect you want in an authorization team: detail-oriented. With insurance, every piece of submitted information needs to be perfect, because one tiny mistake can make the difference between a denial and an approval.
Diane, manager of our JAB team, keeps it simple: “I will fight for what’s right.”
The Right Minds for the Job
All three ladies mentioned above said that they often can’t turn off their authorization-oriented brains at the end of their workday. “Sometimes I will see something that reminds me of a case I am working on and then I start thinking about how I can add more details to the justification letters to really get our point across,” said Lora. Elisa agreed, “For me, I keep thinking about those patients who I have built a relationship with and are counting on me to help them in their fight for their prosthetics.”
Getting the Patient Involved
Over the years, we have found that one of the best ways to get approvals is to make sure the patient is part of the justification process. When the patient is willing to get on the phone, write a letter, speak with their doctor – that can change a denial into an approval. And that kind of responsibility is daunting! We know that. Our JAB Team can walk anyone through the best ways to be involved.
Our patients receive their prosthetic devices because of our JAB Team and their years of experience, know-how, determination and skills. But what do our employees get out of the deal? Lora loves “knowing that what I do helps another individual. When I help write a medical justification letter, and then I see it’s approved, it’s a really good feeling. And later, seeing a video with the patient utilizing the device – it's amazing.”
Diane continued in that vein: “Many of us, myself included, do this because we want to be able to make a positive difference in people’s lives.”
We See You as An Individual
Elisa: “I have heard patients say, ‘I do not feel like just a number at Arm Dynamics.’”
You are not an account number. You are not your amputation. You are an individual who we treat with care and respect from the first time you reach out to us. When you become a patient at Arm Dynamics, there will be many people involved in your care, but the JAB Team is there to support and advocate for you throughout the entire process.