Goal: Display tactful behavior when communicating with providers when communicating with medical providers regarding third party requirements. Show sensitivity when communicating with patients regarding third party requirements. Scenario: Patients preauthorization was denied because a second opinion is required. You must explain to the provider new policies from the insurance company requires a second opinion before they will approve the procedure. You will explain to the patient the new policy of their insurance carrier requiring a second opinion for corroboration of medical necessity before the procedure will be approved. Method: Step Number Procedure Points Possible Points Earned (word minimum 200) 1. Tactfully explain to the providers the insurance carrier’s new policy requiring a corroborating second opinion prior to approval for the procedure. (50) 2. Demonstrate sensitivity explaining to the patient the necessity of a second opinion to corroborate the medical necessity of the procedure prior to approval. (50) Reminders: Display tactful behavior when communicating with medical providers regarding third party requirements. Show sensitivity when communicating with patients regarding third party requirements.
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