Navigating the Medical Necessity Battleground When Payers Balk

Health Leaders: Medical necessity is at the heart of a $40.1 million battle between NYC Health + Hospitals and UnitedHealthcare over what the public health system says are wrongfully denied bills. NYC Health + Hospitals says it's seeking to recover that money through arbitration.

When claim denials result from factors like ineligible members and untimely filing, there's often little to argue. Medical necessity, though, is more of a gray area.

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