Private Payer Resources

If  a private payer inappropriately denies or bundles a procedure or service that you furnished, you can use the Academy’s policy statements, clinical indicators, CPT for ENT articles, Clinical Practice Guidelines to appeal the denial and engage the payers in advocacy. We recommend that you contact your state otolaryngology society or state medical society to report the issue, so they can assist you with it. You can access the contact information for your state otolaryngology society on our website (Log in is required). Additionally, you can contact our coding hotline at 800/584-7773 to assist you with your coding questions prior to submitting your claims. This service is free to AAO-HNS members.

Additional Resources

Contacting Medical Directors: Article from the Academy addressing things to consider before discussing coverage decisions with medical directors

Medical Policies: Websites for the medical policies for national private payers

News and Updates: Includes important updates on coverage policies for national private payers

Appeal Template letters: Sample letters to assist with denials

American Medical Association (AMA): The AMA has established an extremely useful third party payer advocacy department that you can report coverage problems.  If you are interested in filing a complaint against an insurer, you can visit the AMA practice management center to obtain details on this process specific to the state where your practice is located.

Medical Group Management Association (MGMA): Practice management resources from the MGMA

Association of Otolaryngology Administrators (AOA): Practice management resources from the AOA