Can payments increase after appeal?
Yes. Successful appeals can result in reprocessed claims and higher reimbursement.
Why are DIEP flap claims sometimes denied?
Denials often occur due to insufficient documentation, incorrect coding, or payer-specific medical policy interpretations.
What is a peer-to-peer review?
It is a discussion between your surgeon and the insurance company’s medical director to justify medical necessity.
What is an appeal?
An appeal is a formal request asking the insurance company to reconsider a denial.
What is an external review?
An independent third party reviews the case after internal appeals are exhausted.