by Hope Starkman, MD
Helping you Navigate Thru Your Insurance Claims Denial and Appeal Process
Has your insurance company denied treatment, diagnostic testing or coverage for a procedure that your physician has prescribed? Is this denial affecting your physical and emotional health? Is your physician too busy to write up the of appeal letter that might be comprehensive enough to overturn this denial. An effective appeal letter will include a thorough summary about your condition, other conditions and medications which affect the condition for which you are seeking care , prior tried and failed or not tolerated therapies and also references to the current, peer reviewed literature.
Although initial peer reviews are often based on the language of your insurance policy, which is essentially a contractual agreement, often more advanced reviews will focus on objective treatment choices that are based on the current standard of care. This standard is a reflection of the most current peer reviewed literature. It is based on science and established clinical trial outcomes. Although many patients feel that the denial of their treatment or test is random or due to insurance companies not wanting to pay, this is not the case. While it is true that insurance companies try to control cost, which all businesses need to do, the goal is to cover treatments with therapies based on
objective evidence that the therapy is likely to be effective. Insurance companies prefer to cover a treatment which is proven rather than experimental and investigational whenever possible, unless there is no other alternative . Sometimes there really are no other alternatives. It is crucial that your appeal letter be written taking into account all of these factors.
Dr. Hope Starkman has been practicing Rheumatology in South Florida since 1994. She is Board Certified in Rheumatology and re certified until 2024. She has extensive practice management experience, medical peer review experience and clinical rheumatology experience. She attended and graduated the prestigious Barnard College of Columbia University in 1985. She graduated Albany Medical College in 1989. Her internship and residency were completed at Beth Israel Medical Center (New York City) in affiliation with Mount Sinai Hospital in 1992. She then completed a fellowship in Rheumatology at Montefiore Medical Center in affiliation with Albert Einstein College of Medicine in New York in 1994. Dr. Starkman relocated to South Florida to practice clinical Rheumatology in 1994. She has worked in various clinical settings including as a Hospitalist at the former Doctor’s Hospital (now Beth Israel Hospital Affiliate) and Gracie Square Hospital and also as a Emergency Room Physician in New York
City in multiple hospitals and in ambulatory care facilities, prior to entering private Rheumatology practice. Dr. Starkman, now spends a lot of time performing Rheumatology patient chart peer reviews to assist in determining the medical necessity of various treatments and diagnostic tests.
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