“Patient's coverage verified, Authorization obtained, OP note is properly documented, Claim is billed correctly - Insurance denied the claim." In 𝐈𝐧𝐬𝐢𝐝𝐞 𝐭𝐡𝐞 𝐏𝐫𝐚𝐜𝐭𝐢𝐜𝐞, 𝐄𝐩𝐢𝐬𝐨𝐝𝐞 𝟐, I sat down with a 𝐡𝐢𝐠𝐡𝐥𝐲 𝐞𝐱𝐩𝐞𝐫𝐢𝐞𝐧𝐜𝐞𝐝 𝐬𝐮𝐫𝐠𝐢𝐜𝐚𝐥 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞 𝐦𝐚𝐧𝐚𝐠𝐞𝐫 to unpack what it takes to navigate complex insurance denials: tracking calls, documenting timelines, setting up peer-to-peer reviews, keeping patients informed, and bring in payments for surgeries. It’s a conversation packed with real-world strategies that every practice can benefit from. 🎥 Watch the full episode on YouTube (link in comments) #InsideThePractice #Healthcare #MedicalBilling #SurgicalPractice #InsuranceDenials #PracticeManager #HealthcareAdministration

🩺 The Games Insurance Companies Play — and Why Physicians Must Keep Fighting for Our Patients Every day, we see how insurance companies manipulate the system to delay, deny, and deter patient care. Through loopholes, arbitrary denials, and endless “reviews,” they prioritize profit margins over patient outcomes. As physicians, we can’t allow this to become the norm. Our duty extends beyond the clinic — we must advocate relentlessly for our patients when the system fails them. I recently responded to yet another denial for a life-saving device, a reminder that these decisions are not abstract policy issues. They affect real people, with real lives hanging in the balance. ⸻ 💡 A Step in the Right Direction: The National Coverage Decision on CCM The recent national coverage decision on Cardiac Contractility Modulation (CCM) represents a significant win for patients and physicians alike. For years, private payors have exploited a loophole to deny access to CCM — a proven, life-changing therapy for heart failure patients. Now, with CMS formally recognizing CCM under national coverage, there’s no longer room for ambiguity. This sets a strong precedent for private insurers to follow — and a reminder that persistence in advocacy works. ⸻ ⚖️ Our Role Moving Forward This success didn’t happen by chance. It’s the result of years of evidence-based advocacy and clinicians refusing to accept “denied” as an answer. We must continue to: • Speak up for our patients • Document and challenge unjust denials • Push payors to align with science, not spreadsheets Because every delay has a cost — and every unjust denial has a name. ⸻ #PhysicianAdvocacy #HealthcareReform #PatientFirst #CardiacCare #HeartFailure #CCMTherapy #MedTech #HealthcareJustice #InsuranceDenial #MedicalNecessity #Cardiology #CMS #HealthPolicy #PanicoProfessionalConsulting #PhysiciansForPatients Impulse Dynamics Jason Spees Ishu Rao Anthony Hong Gary Cranke Doug Nock Michael DiVerde Rohan More Allison Nash Jason Kindler Shaun Grams Thomas Sapienza CVAM, CardioVascular Associates of Mesa, P.C.

The Canadian Dental Care Plan (CDCP) is a federal government initiative to improve access to oral health care for Canadians, who lack private or employer-sponsored dental insurance. Our new resource, developed in partnership with the Faculty of Dentistry, University of Toronto, is intended for public health units to support residents seeking guidance on dental benefits, provides information on key topics including eligibility requirements, the application process, covered services and the benefits available under the CDCP. Check it out now. https://vist.ly/4b48v

We're proud to partner with The American Institute of Dental Public Health for Veteran Oral Health Week, an annual national campaign dedicated to raising awareness and sharing resources for veterans’ oral health. Connecticut is home to over 150,000 Veterans, with more than 36,000 residing in Greater Hartford. Many Veterans, once out of active duty, are no longer eligible for dental insurance through the Veterans Administration. Some may have private insurance, but lower-income Veterans often do not qualify for Medicaid and cannot afford private plans due to pension-related income limits. At COHI, we're increasing capacity for Veterans' oral health through our newest initiative, Salute to Smiles. Made possible by Delta Dental Foundation, this program provides free dental care to Greater Hartford Veterans with a limited VA connection and financial constraints keeping them from getting the oral health care they need. Veterans cannot be fully healthy without proper oral health care. Salute to Smiles seeks to honor their service by connecting them with quality oral health education, preventive care, and treatment resources. Learn more and sign up at: ctoralhealth.org/salute #VeteransOralHealthWeek #SaluteToSmiles #dentalcareforvets #oralhealthforall #hartfordct #greaterhartford #ctvets #ctveterans #connecticut

Every hospital fights a quiet battle you rarely see. It’s not in the operating room or the ICU. It’s the moments after, when a patient is ready to go home, but the process isn’t. At Carilion Clinic, the Care Management team saw how much time slipped away in that space between “ready for discharge” and “placed for care.” Each delay meant a bed that couldn’t open and a patient waiting longer than needed. They decided to fix it. The team built the Post-Acute Referral Center, a single place where every case manager and social worker across seven hospitals could see referral status, insurance authorization, and placement availability in real time. The results speak for themselves: - Nearly 130,000 referrals managed. - A 19-hour improvement in referral-to-acceptance time. - A full day saved for patients needing prior authorization. But what mattered most was the time they got back. Time to care. Time to plan. Time to move patients home faster. I'm incredibly proud to have them as a case study others can learn from. Thank you for your partnership, Carilion Clinic.

Prevent Blindness Launches Online Patient Resource on Insurance Benefits for Eye Care- Eyewire+ With open enrollment in #Medicare and the Affordable Care Act Marketplace underway, Prevent Blindness has launched a new online educational resource to help individuals and families better understand their vision and eye care benefits. According to Prevent Blindness, the new guide, “Understanding Insurance Benefits for Eye Care,” breaks down the often-confusing landscape of insurance terms, coverage types, and benefits related to eye exams, glasses and contact lenses, medical eye care, and surgery. The resource also reportedly offers links to additional information on vision care financial assistance programs, opportunities to engage in eye care advocacy, and a platform for sharing personal vision stories. The resource may be found at https://lnkd.in/geh-NNZu. https://lnkd.in/grfjaMUh

“When Denial Becomes the Default” A new report found that insurance companies deny one in five medical claims in New York — 59 million rejections a year, worth over $89 billion in care delayed or denied. As a Family Physician, I see what that means in real terms: patients waiting weeks for imaging, meds, or procedures because of “prior authorization.” Families caught between illness and insurance. As an educator, I see future physicians learning that before you can heal, you have to justify care to a system built on suspicion. And as a Clinical Dean, I see the downstream impact — fewer clinical sites, overworked preceptors, and students witnessing a system where paperwork outweighs judgment. When nearly half of appealed denials are overturned, the issue isn’t provider error — it’s a system error. Insurance reform isn’t just policy; it’s about reclaiming time, trust, and purpose in medicine. Our next generation of physicians deserves to practice in a system where care is guided by clinical need — not denial rates. #MedicalEducation #HealthPolicy #PrimaryCare #PhysicianLeadership #HealthcareReform #ClinicalEducation

❗️ Physicians and surgeons: Considering a shift in 2026? Changing jobs, switching carriers, or thinking about retiring from medicine? 🩺 Tail malpractice insurance is what protects you from claims that show up after your policy ends — and understanding your options now can save you thousands later. This 2026 guide breaks down: ✅ When you must have tail coverage ✅ What it actually covers (beyond just legal fees) ✅ How long coverage should last ✅ Alternatives like nose coverage and occurrence policies Worth a read if you want to protect your future self 👇 https://buff.ly/HGuxsXC #Physicians #MalpracticeInsurance #TailCoverage #HealthcareRiskManagement #MedicalProfession

A Hard but Necessary Change — Why We’re Moving Out of Network with United Healthcare This month marks a big shift for us at Crossroads Physical Therapy — we are officially out of network with United Healthcare. This wasn’t an impulsive decision. It’s one that’s been building over the year with careful thought, conversations with patients, and the realities of trying to sustain a small, family-owned outpatient practice in today’s insurance landscape. Before PT school, I worked in medical billing for three years. I understand the payer side, the codes, the authorizations — and I don’t take that knowledge for granted. I’ve also seen firsthand how these systems impact both the patient experience and the ability for clinics like ours to survive. Here’s what the last 15+ years with United have looked like: 💸 No increase in reimbursement since 2009 — 3 units, $70 / visit cap 📉 Rising patient costs: UHC Medicare plans that once paid a $20 copay with a $50 insurer payment have flipped — now $50 copays with $20 insurer payments. 🌀 Excessive authorization barriers disguised as “notifications.” 📑 Denials on legitimate, medically necessary care. At first, we were patient. We were new, hopeful, and willing to absorb the losses because we believed access mattered most. But as more clinics began to move out of network, our UHC caseloads grew — and the cascade of effects was undeniable: • We couldn’t offer competitive wages to retain great clinicians. • We were forced to choose between quality and quantity. • We risked losing our ability to provide true 1:1, patient-centered care. And that’s where we drew the line. We chose to stay aligned with our values — quality care, professional integrity, and transparency. We educated our patients, we explained the “why,” and we helped them understand their out-of-network options. It wasn’t easy. But it was necessary. To every clinic and clinician navigating similar decisions — you’re not alone. These aren’t just business choices; they’re about protecting the soul of our profession and the standard of care our patients deserve. #PhysicalTherapy #PrivatePractice #HealthcareAccess #InsuranceReform #UnitedHealthcare #SmallBusiness #CrossroadsPT #Advocacy #Leadership

💡 A Stronger OPD Framework Means Stronger Claim Savings Insurance customers today expect reliability, transparency, and continuous access to quality healthcare. With rising OPD and diagnostic expenses, a structured preventive model is essential for long-term cost control. At DoctorPe, our 1-year OPD package is designed to support insurers with: ✅ Unlimited doctor consultations ✅ Unlimited lab and radiology tests ✅ Preventive screening for diabetes, vision issues, and mental-health risks ✅ 10 percent reduction in hospitalization costs ✅ Up to 20 percent savings on OPD-related claims All services are available at just ₹999 per customer annually. 🤝 We welcome collaboration to deliver better healthcare outcomes while reducing claim burdens for your customers.