the patient and the medical professionals. The top 3 things a professional and a patient can do to appeal their claim. The ways a medical review can assist the top 3 things a professional can do. Keywords: medical bill review,utilization review,medical record review,medical chart review,physician peer review,hospital peer review,medical reviews,peer review organization,medical review,medical peer review Article Body: If you are like most people, when your medical insurance declines your claim, you are left feeling helpless and frustrated. After all, if you need health care and your insurance is saying you donÆt, you have two choices û appealing your claim or paying for the treatment out of pocket. Most claims are declined for specific reasons and causes. The most likely cause for your health plan to deny your claim is a direct consequence of missing data. Before appealing your denied claim, you can verify that by assuring any and all pre-authorization requests were filled out with accurate patient information. For example, is your social security number correctly listed? Does the doctor have the most current copy of your health planÆs identification card? Does your doctor have the most up to date copy of diagnosis and procedure codes in order to fill out the forms correctly? By verifying that you have submitted the good documentation to the physician and they in turn submitted good documentation the health plan, you are ready to move to the next level. When it comes to dealing with your health insurance company, think paranoid. Document every phone call, every contact person and every piece of information you are given. It only takes one break down in communication to cause a problem; by documenting all of your communication with the insurance company, you are pre-preparing for any appeals case. If you are facing an appeals claim for treatment coverage, be sure youÆve reviewed the appeals process in your companyÆs health insurance handbook. Most patients overlook reading through the handbooks their insurance company will provide. Plan requirements and appeal processes are detailed in these handbooks and you should make sure that your plan covers any treatment you are going to receive before the treatment is received, if possible. When An Appeal Is Necessary Since every plan should have a clear appeals process, you should follow it explicitly. You should talk to your doctor about appealing the claim so they can provide supporting documentation and expertise
piece
is
an
abstract
triptych
that
I
found
while
I
was
in
Atlanta
buying
religious
paintings
The
piece
was
called
Guardian
Angel
and
I
love
it
My
patrons
fell
in
love
with
it
as
well
They
have
asked
me
to
track
down
the
artist
and
see
if
he
has
anymore
religious
paintings
available
The
only
religious
paintings
that
I
actually
do
not
buy
are
ones
that
reflect
the
image
of
Jesus
on
the
cross
I
don’t
have
a
problem
with
them
some
of
them
are
extremely
well
done
and
would
more
than
likely
sell
well
but
my
investors
made
it
very
clear
when
they
financed
the
gallery
that
I
would
not
put
that
image
into
it
PPPPP
683
Ajello
Candles
The
motto
of
the
Ajello
Candle
Company
is
“It’s
better
to
light
a
candle
than
to
curse
the
darkness”
This
candle
making
company
has
been
in
business
since
1775
The
business
has
been
family
owned
for
seven
generations
The
candles
from
Ajello’s
are
well
known
for
their
beauty
and
quality
While
they
make
more
candles
now
than
in
1775
their
dedication
to
quality
and
to
customers
has
never
changed
The
Ajello
Candle
Company
was
founded
by
Rafael
Ajello
an
Italian
painter
He
was
also
a
beekeeper
so
he
tried
his
hand
at
using
bees
wax
to
create
candles
He
worked
hard
to
create
a
formula
that
worked
well
The
formula
combined
with
his
outstanding
artistic
ability
lead
to
the
birth
of
the
Ajello
Candle
Company
In
1785
the
company
earned
the
honor
of
creating
all
the
candles
for
the
Vatican
He
and
his
wife
ran
the
business
keeping
their
children
involved
in
the
processes
from
an
early
age
As
time
went
on
their
children
and
grandchildren
kept
the
business
running
as
well
as
passed
the
family
business
on
to
their
children
By
1862
the
company
had
established
itself
as
a
leader
among
the
candle
making
industry
They
had
also
added
perfumes
and
many
.
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