Lab Stewardship Hot Topic: Helping patients win insurance appeals for medically necessary testing

Tuesday, November 20, 2018
Lab Stewardship Hot Topic: Helping patients win insurance appeals for medically necessary testing
Tuesday, November 20, 2018 11:00 AM - 12:00 PM (Pacific Time)


Description of Program Content:

This webinar will outline why insurance companies deny claims for medical necessity, what information is need to appeal and the process for appealing these denied claims. The presentation will cover processes that tend to apply to most insurance companies. Please keep in mind that each payer may have a slight variation based on their internal processes or state insurance laws.


Measurable Learning Objectives 
At the end of this activity the participant will be able to:

1. Explain why insurance companies deny “medically necessary” claims
2. Understand what information is needed to appeal these claims
3. Understand the general process for appealing these claims


Presenter:  Natalie Thurston RN, MBA, CPHQ

BIO
Natalie Thurston RN, MBA, CPHQ is a health care reimbursement professional. With almost 20 years of experience, Natalie has the unique perspective of working on the insurance side and provider side of healthcare. Insurance experience includes managing a team of clinicians responsible for guiding members to the Humana National Transplant Network, and implementing Humana’s new clinical program (Personal Nurse). Currently, Natalie is utilizing her insurance experience in her current role with a California based provider to obtain positive coverage decisions and contracts for a molecular diagnostic test. Her ability to obtain coverage covers both commercial and government lines of business. Examples of successful positive coverage decisions includes Humana, Cigna, Highmark, BCBS Kansas City, Wellmark, California Medicaid, Florida Medicaid, and NY Medicaid. She has a comprehensive understanding of insurance operations from claim submission thru payment.
Natalie received a Bachelor’s in Nursing (BSN) from Indiana University – Indianapolis and a Master’s in Business Administration (MBA) from Indiana University Southeast. She also maintains a certification in Healthcare Quality (CPHQ).









 

Contact Information

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    Medical Training Solutions, Inc. 
     
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    MTS
    ATTN: Laboratory Webinars
    PO Box 17349
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