Denied for medical necessity??

My eAssist team member and I had an SRP claim from June 2018 that had been denied due to “medical necessity”. The office had already appealed a couple of times before we came on in Jan 2019. They received a letter just before we started that stated it was overturned and they could resubmit info to be reprocessed. Well then UHC told them they didn’t have any such letter on file. It got turned over Maximus Federal Services. My team member called every 14 days talking with several different reps with Maximus or leaving messages with reps and just totally getting the runaround from them. They kept changing admins and losing the submitted info. Well, it turns out the patient had passed away in the midst of all this so we’re thinking they were hoping we would just write it off. My team member had WAY more patience than I would have had and we FINALLY got payment today!!!!

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