Copyright © 2007 - 2011
Mathias Masem, M.D.
All Rights Reserved

Diagnostic Tests

Authorization Process for Special Diagnostic Tests

How long does it take to get permission from my insurance company to proceed with the recommended testing procedures, surgery procedure or medical consultation?

To begin the insurance authorization process for special tests and procedures, please complete the INSURANCE UPDATE FORM in a timely manner.

Getting authorization from your insurance company is an involved process which can take from 3-12 weeks. At Bay Area Hand Surgery Associates, we will work diligently with your insurance company so there is minimal delay in the treatment of your hand or upper extremity injury. These are the following steps our office follows for acquiring authorization for special tests and procedures.

  1. Our office staff contacts the claims adjustor and makes a REQUEST and EXPLAINS the reason for the special test or procedure. To begin this process, we need accurate information from the INSURANCE UPDATE FORM.
  2. Our physician then must DICTATE a report that justifies why the procedure is important to the care of the hand or upper extremity condition. This report is TRANSCRIBED by an outside transcriptionist. This report process can take from 3-10 days to complete.
  3. Our office staff then FAX the physician’s request and copy of the dictated report to the claims adjuster.
  4. The adjuster REVIEWS the request and attached report and DECIDES whether the request will be approved.
    • The adjuster may seek the advice of a UTILIZATION REVIEW (UR) nurse or a CASE MANAGER to make the decision.
    • The adjuster may seek the advice of another DOCTOR to see if they agree with our physician.
    • The adjuster returns documentation to our office either authorizing or denying our request for special tests or surgery.
  5. If you have not heard from our office regarding your authorization, our Nurse Practitioner can intervene and provide help for this process. This requires that you come in for an appointment.
  6. If the request from the insurance company has been AUTHORIZED:
    • Our office will call you to schedule your special test or surgery appointment.
    • After the special tests or procedures have been completed, you will need to see your physician or Nurse Practitioner to review the results and determine a medical treatment plan.
  7. If the request has been DENIED:
    • Our office will call you with the authorization denial.
    • This office cannot proceed further until the request is authorized.
    • The most common reason for denial is that the adjuster doesn’t see the connection from the original injury claim to the current request.
    • If you have settled an injury claim with no further medical coverage, you will be financially responsible for any and all future treatment either with your private insurance or through private pay.

For any additional questions, please contact our office manager. Our physicans and nurse practitioner are always available to answer any questions regarding your medical treatment plan.