Hospitals frequently face denials when payers question whether services were medically necessary. Typically, these denials take place after the hospital has already provided treatment, expecting to be reimbursed for the expenses it has incurred in caring for its patients, only to discover that the payer is refusing to pay.

At that point, HLS can step in to appeal these denials by analyzing the medical records and applying state and federal definitions, industry guidelines, and payer policies to craft an argument for why the services should be paid. We combine the knowledge of our on-staff clinical experts with the extensive training in medical practice, terminology, and symptomology that all of our staff undergo to ensure that all of our appeals appropriately address the clinical rationale for care. In this way, we are able to get many denials overturned even after they have been reviewed by the hospital’s in-house appeals team or physician advisor and judged to be unworthy of contesting.