What “Not Medically Necessary” and” Experimental/Investigational” Really Mean for Patient Access to Innovative Medical Technologies
A “not medically necessary” or “experimental/investigational (E/I)” decision can be frustrating, especially when a provider believes an innovative medical device is appropriate for the patient. A medical insurance denial may reflect documentation, payer policy, coding, or a technology-level coverage classification. This article explains what a medical necessity or E/I denial means, the common reasons behind […]
Why Denials Management for Medical Devices Is Fundamentally Different From Standard Authorization or Claim Denials
Standard denial management works because the rules are known. A physician’s office submits a claim for an established procedure, the payer checks it against existing policy, and any denial follows a predictable pattern with a predictable fix. New and emerging medical technologies don’t get that luxury. When a device launches without an established payer coverage […]
Wound Care Patient Access
A 6-Part Educational Video Series on Skin Substitute Coverage and Market Access Join Jacob Durant and Danielle Bargull, Senior Manager at JDL Access, for a 6-part video series designed to educate providers, manufacturers, and healthcare professionals on Medicare and commercial insurance coverage for skin substitutes. These educational episodes cover everything from reimbursement and claims submission […]