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.
"Hello, sir/madam. We apologize for the inconvenience this may have caused, but there has been a slight change in our insurance policy that you need to be updated with. We require our patients to acquire a second opinion from a doctor of your choosing that supports the first one. Only then will we be able to process your pre-authorization. Thank you for your understanding and cooperation."
He should turn it into his boss and say “____ put this in my coat,(and if he doesn’t know what the drug is) what does this drug do?” Never take home drugs you dont need
