Those who don’t know the technical jargon and the necessary documentation can easily get lost when it comes to securing their rights.
Obtaining authorizations for surgical procedures is a complex process and is often marked by bureaucracy and delays. However, new strategies are being implemented every day to transform this reality.
According to the expert Rudolph Damascene, the search for solutions to guarantee patients’ rights becomes increasingly relevant. A survey conducted by the University of São Paulo (USP) between 2013 and 2014 already showed that surgeries accounted for the majority of health insurance denials (34%).
Since then, between 2011 and 2021, lawsuits filed against the industry have increased by 239%.
“When the reason is denial of coverage, 93% of cases are won by patients, which demonstrates the need to review these criteria for approving and denying surgeries,” he assesses.
The authorization process involves several steps, from the initial request to approval by healthcare professionals. Traditionally, this process has been slow and error-prone, causing frustration for both patients and doctors, as well as delaying essential treatments.
However, with the advancement of technologies and the development of new methodologies, this process tends to become more efficient, transparent and customer-centric.
Those who are unfamiliar with the jargon and documentation required to get a procedure approved by health insurance companies and plans can easily get lost when it comes to securing their rights.
Step by step
The first step, therefore, is to inform yourself and have all the required data and tests at hand. “Presenting detailed and transparent documentation, such as detailed medical reports, test reports and a clear justification of the essentiality of the intervention, for example, reduces the need for additional information and contributes to the effectiveness of the authorization,” underlines Damasceno.
In this way the treatment is carried out more efficiently, avoiding the traditional requests for new documents and tests. These are the bottlenecks in the system that lead to denials or even delays in surgical procedures that can save lives.
The major challenges faced in the surgical authorization process include ineffective communication between hospitals and healthcare providers, lack of standardization in required documents, and the absence of a centralized system for tracking requests. These barriers not only delay patient care but also increase operational costs for healthcare institutions.
inspires transformation in the world of work, in business, in society. Compasso, a content and connection agency, is born.
Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
