Managed Care Nursing

Category - Patient Issues

An insurance company denies a claim and the patient appeals directly to the entity. A full and judicial review of the decision is in order, and an urgent request may be made based on criteria.

Which of the following matches the above scenario?
  1. Appeals review
  2. Interagency review
  3. External review
  4. Internal review
Explanation
Answer: D-If an insurance company denies a claim and the patient appeals directly to the entity, this is referred to as an internal review.
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