Denials: The Hidden Industry and How Practice Solutions Fights for You

Insurance billing is often one of the most complex and frustrating aspects of running a practice in mental health care. Many therapists, dedicated to helping their clients, find themselves entangled in a system designed to deny their claims rather than support the care they provide. While it's easy to feel isolated in this struggle, there’s a deeper story at play—one that highlights a hidden industry dedicated to controlling healthcare costs by limiting payouts.

A recent ProPublica article shed light on the operations of companies like EviCore, which handle prior authorization processing for large insurance companies. The process described in the article revealed an alarming truth: prior authorization reviews are often automated and governed by algorithms that predict the likelihood of approval. Prior authorization requests scoring below certain thresholds are flagged for additional scrutiny, and insurance companies can adjust these thresholds depending on how many denials they want. This practice profoundly impacts private practices, as therapists are left to battle bureaucratic obstacles to be compensated for their essential work.

The Reality Behind Insurance Denials

While some therapists believe there is a quota for denials, the truth is that insurance companies focus on "controlling the spend." This means they aim to minimize the amount paid out for claims, using strategies like the one employed by EviCore. These tactics create barriers between therapists and their compensation, disrupting the flow of services and potentially discouraging them from accepting insurance.

For therapists in private practice, denied claims and prior authorization requests are more than just a financial burden—they also disrupt the care continuum. Denials often lead to delays in treatment, leaving patients without the support they need while their providers work to resolve insurance issues. This system creates unnecessary roadblocks in the therapeutic process, and both the therapist and client suffer as a result.

Standing in the Gap: How Practice Solutions Helps

At Practice Solutions, we understand how devastating claim denials can be to a practice's bottom line and overall success. Our mission is to bridge the gap between your practice and the insurance companies seeking to control costs at your expense. We are proud to partner with therapists who want to focus on helping their clients instead of battling with insurance companies.

We take on the burden of fighting claim denials, so you don’t have to. Our billing professionals are well-versed in the intricate policies and strategies insurance companies use, and we leverage our expertise to ensure that your claims are processed and paid on time. Whether your claim was flagged by an algorithm or sent for review due to a technicality, our team works tirelessly to advocate for your practice and clients.

Take Action Against Denials

If your practice struggles with claim denials, don’t let insurance companies control your revenue stream. Contact Practice Solutions, and let us fight that battle for you. Our expert billing team will manage the denials process, allowing you to focus on what you do best—providing excellent care to your clients.

Contact us today to learn how we can help you overcome insurance claim denials and streamline your billing process. Let us be the bridge connecting your dedication to patient care with the financial stability your practice deserves.