Disclaimer: This content is educational and based on 20+ years of case management experience. It is not medical advice, clinical guidance, or legal counsel. Consult with qualified healthcare providers, case managers, and legal professionals for decisions affecting your care.
What if I told you medical approvals have nothing to do with medical necessity?
What if I told you that clinical documentation, GG scores, even technically committing documentation fraud has WORSE results than what I'm about to reveal in the next day or two?
And unlike fraud, this method is 100% legal. Mostly.
Against the advice of legal counsel, Last Resort Publishing is releasing what the insurance industry has spent millions trying to keep buried.
But First, Let Me Ask You Something...
How many times this week have you:
- ✓ Submitted flawless documentation only to get denied?
- ✓ Lost a P2P despite overwhelming clinical evidence?
- ✓ Watched a reviewer ignore objective data?
- ✓ Wondered if there's something you're missing?
For 48 Months, I've Been Studying What Actually Works.
Not what SHOULD work. What DOES work.
I've personally coached attending physicians through 100+ P2P calls. I've analyzed over 500 insurance interactions. I've tracked every variable, measured every outcome, and discovered something that will fundamentally change how you approach medical approvals.
You're not missing clinical knowledge. You're missing THE GAME.
Here's what I discovered when I started studying the game instead of the medicine:
I found that P2P calls scheduled at 4:52 PM on Fridays have a 41% higher approval rate than the same clinical case presented Monday at 9 AM.
Same patient. Same documentation. Same medical necessity. Different time = Different outcome.
Let that sink in.
Stay tuned. More to come.
P.S. - If you work for an insurance company and you're reading this, two things:
- We know about the Friday thing
- Ashley from Chapter 23 says hi
P.P.S. - Not medical advice. Not legal advice. Possibly not even good advice. But it works.
'Last Resort™' is made up but the brokenness isn't. These opinions? They're mine. Shaped by two decades of care coordination, grief, absurdity, and a drawer full of denied post acute brain injury rehab program requests.
Disclaimer: Not speaking for my employer. But definitely speaking for the rehab case manager who hasn't peed since 7 a.m. who is still on hold, still holding it AND still found time to advocate for a patient's ambulance ride home.