HEALTH TECHNOLOGY

ZetrOZ Systems Highlights the Rise in Health Insurance Denials, Provides Solution

ZetrOZ Systems | May 30, 2022

ZetrOZ Systems Highlights

ZetrOZ Systems, leaders in wearable medical technology and makers of the sam® wearable ultrasound device that heals soft tissue, highlighted the rising health insurance claim denials. The organization is encouraging customers to inform themselves about their healthcare policies and challenge the first denial.

Millions of people in the U.S. have experienced the devastating denial of their healthcare claims. According to Change Healthcare, 11% of 102 million medical claims at 1,500 hospitals are denied at first. The rate of denials has gone up by 20% since the year 2016. 

"Unfortunately, medical policies are driven by insurance company profits and fear of change. Thus, patients are often denied advanced new care when they need to access their healthcare benefits for soft tissue injuries." 

George K. Lewis, Ph.D. and CEO of ZetrOZ Systems

"The first 'no' by an insurance policy can be turned into a 'yes' if you are informed and persistent," Lewis continued. "At ZetrOZ, we encourage patients and providers to not simply give up with the first denial of an insurance claim for therapies like Sustained Acoustic Medicine (sam®). Your insurance should always cover treatments that are proven to be both medically effective and cost-effective."

If a denial letter is received, consumers can appeal against the decision. Possible issues include inaccurate paperwork, incorrect billing code, misplaced tax ID or wrongly coding the prescription or procedure. 

Inspite of sam®’s success, it is usually not covered by the first line of treatment. The reason is often an inadequate understanding of the costs and care by patients, insurers, and insurance providers.

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Spotlight

To address data management requirements, healthcare organizations need an architecture that can process data from various sources and route information to a wide variety of new destinations. Red Hat’s Intelligent Data-as-a-Service (iDaaS) solution can help. It provides inbound connectors, message consumption, a business rules engine, an action engine, federated access to data sources, caching, and outbound connectors.

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