Tuesday, September 19, 2006

Talk Like an Insurance Claims Reviewer Day


In recognition of Talk Like a Pirate Day, I though I would give some modern-day examples of Pirate-speak:

Example 1
Avast matey:
Afterrr rrreviewin' th' inforrrmation, ourrr barnacle-co'erred Medical Dirrrectorrr has a fierce fire in his belly that tharrrwe must upbe holdin'th' denial o' co'errrage ferrr 'ese 'errreserrrvices on th' basis that tharrrtherrre be no documentation o' medical necessity ferrr th' rrrequest'd serrrvices or burried trasurrre.

Example 2
Ahoy Thomas Cook:
At yerrr rrrequest, Health Alliance rrreview'd yerrr rrrequest ferrr prrre-authorrrization ferrr Stump Expanderrr Reconstrrruction o' a left pegleg deforrrmity, and a bottle of rum!

We have rrreceiv'd a letterrr frrrom yon Drrr. James Ferguson. Bas'd on rrreview o' this letterrr know ye th' surrrgerrry would be considerrr'd cosmetic and therrreforrre, be not co'errr'd on yerrr plan.

If ye have any questions orrr wish t' submit some additional godforsaken inforrrmation ferrr rrreview, please shout orrr
wrrrite t' th' Medical Management Deparrrtment at th' addrrress and phone numberrr list'd below, ye scurvy dog!
Red Rackham, R.N.

Example 3
Dear William Kidd:
Unit'd Healthcarrre has rrreceiv'd an inquirrry rrregarrrdin' th' eligibility o' co'errrage ferrr yerrr right hookie device.

Because this prrrocedurrre be not a basic health carrre serrrvice and be not considerrr'd medically necessarrry, it be not a co'errr'd benefit b'lowyerrr plan. Co'errrage crrriterrria o' serrrvices is explain'd in detail in yerrr foul blaggarrt Unit'd Healthcarrre memberrrship materrrials.

The Customerrr Serrrvice Deparrrtment be hankerin' tobe answ'rrrin' any questions ye may have rrregarrrdin' th' charrrges ferrr which brrrackish ye will be rrresponsible should ye elect t' have this prrrocedurrre, matey!

Please rrreferrr t' yerrr blasted Unit'd Healthcarrre memberrrship materrrials ferrr inforrrmation, orrr contact th' Unit'd Healthcarrre Medical Management Deparrrtment. Ya horn swogglin' bilge rat!!

Example 4
Ahoy Neddy Teach:
Aye, ye have th' right t' appeal this deterrrmination as outlin'd in yerrr fleabag Summarrry Plan Descrrription.

Me dear ol mum, bless her black soul, tol me ye may initiate an appeal wit' Unit'd HealthCarrre by followin' th' prrrocedurrre outlin'd below. Unit'd HealthCarrre offerrrs two le'els o' appeal, be they th' Skull or Scuppers. At ev'rrry le'el, yerrr appeal will be rrreview'd by a Unit'd HealthCarrre Medical Dirrrectorrr orrr an independent medical consultant (that be me mate, ol Rumpot, who'll swill a pint or two of grog!).

To do so, please submit th' followin' medical inforrrmation within sixty (60) days o' rrreceipt o' this notice, else we'll seize all yer booty. Gar!!!
Plundering insurance premiums or the Spanish Main, what's the difference? Aarrgh!