Denied. Pending. More Paperwork: What Insurance Companies Are REALLY Telling Doctors

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What Insurance Companies Are Really Telling Doctors

Prior authorization is supposed to help manage healthcare costs and ensure appropriate care. But what happens when the process becomes a barrier between doctors and their patients?

In this episode of Credentialing Chronicles, Shannen and Nyleen take a closer look at what the newly published data is revealing about prior authorization — including denial rates, appeals, retrospective denials, and the administrative burden placed on physicians and their teams.

We’re looking at the numbers coming out of Georgia, what they mean for providers and patients, and why transparency may be changing the conversation around insurance denials.

And there’s one statistic you’ll want to hear: 82% of appealed prior authorization denials are overturned.

So why are so few denials actually appealed?

🎧 Listen to this week’s episode of Credentialing Chronicles and hear what the data is really telling doctors.

If this episode makes you think of a provider, credentialing professional, or healthcare colleague who needs to hear it, share it with them — and don’t forget to follow Credentialing Chronicles for more healthcare tea. ☕️

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Resources Mentioned:

🔎 Verify Your Doctor’s Credentials

✔️ State-Specific Medical Board License Lookup:
Find your state’s board here:
https://www.fsmb.org/contact-a-state-medical-board/

✔️ Medicare Exclusions List (LEIE) – Check if your provider is federally excluded:
https://oig.hhs.gov/exclusions/exclusions_list.asp

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

For Medical Staff Professional: 

✔️ FSMB.org – Federation of State Medical Boards Physician Lookup:
https://www.fsmb.org/physician-license-lookup/

✔️ Hospital Websites:
Many hospitals have public directories listing credentialed medical staff. Look for a “Find a Doctor” or “Medical Staff Directory” page.

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

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Open Payments

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Verify your Nurses' Credentials: 

https://www.nursys.com/

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