Board/bored certified EM physician. Managed care denials / appeals expert and hating all things insurance. Bourbon collector. Space enthusiast.

Midwest
Joined May 2021
How has nothing new leaked about the Elden Ring movie
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Totally conquered Medicare advantage inpatient auth denials, batting a 98% overturn rate. Now tackling post-acute authorization denials. Our system was at 10% appeal overturn rate. Currently at 75%. Pushing that to 98%. I think it's possible. Fuck private MA programs.
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$ABCL is done presenting at their conference, dying to know the phase 2 results they presented
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Its sad They write AI denials I have an ai agent that writes AI appeals to overturn them (I just dump entire chart and denial letter into agent and it spits out appeal) Robots fighting robots. Almost always win tho lol
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Yaaaaaaay took another healthcare insurance company to court again today! Feeling good vibes about it Making change, one case at a time. This case took a year from file/go to court
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Random reminder to the world for combating health insurance denials Commercial: lvl 1 appeal-->lv1 2 independent review Medicare Advantage: MEMBER appeal (95% chance of OT), if upheld to IR --> ALJ (court) if still worth fighting Medicaid: lvl1 1 appeal--> STATE FAIR HEARING
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Yet evidence prevails over all, and none was presented. Conspiracy is not evidence
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Tried to take an insurance company to court today overturned their denial 1 day before the court session This system is so rigged. They avoided the fine by just overturning, when they could have done that half a year ago when the case was first denied.
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Rare bourbon collection expanding! Getting pretty obscure now. Added to the collection is EH taylor Warehouse C
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Completed the core Blanton's collection! Added green label.
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THIS is how you BREAK commercial insurance companies. Don't complain on TikTok. Don't whine to your friends. Shunt the denial to an independent reviewer, who takes power from the insurance company. Also, aggregate losses at independent review tank their financials.
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I was supposed to go to court with two different health insurance companies this month. One of them did the whole delay, deny defend thing and postponed court another month. Aggravating. Justice will win!
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Bourbon hunting while visiting Santa Barbara and Blanton's Black joined the collection at a nice price!
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I am genuinely shocked that people don't realize hospital consolidation is a response to insurance power. "More independent hospitals" means less bargaining power and easier targets for national companies. Only strong can fight strong.
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Anyone need any help with working an insurance denials? Bored. I usually do inpatient med necessity but honestly that's harder than outpatient
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The best rebellion anyone can have against Medicare Advantage and the fraud they bring is to drop them. Traditional Medicare is more expensive but has far fewer hoops/denial issues. This includes systems, they need to be brave enough to drop all MA plans.
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Casual reminder to anyone fighting a Medicare Advantage denial-- Why aren't you doing a member appeal instead of a provider appeal? 4208-F went into effect this year and it's going to bend MA plans over. I'm already doing it!
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$OPTX apparently just not caring about macros no clear catalyst. no news. Just riding up @anduriltech 's ass with profit. For some reason.
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