ER is different. I have learned to beat the insurance companies at their own game for the most part. They have to publish their treatment criteria. Therefore, I always make sure that the criteria is not only met, but documented in the note. Cuts denials way down. Opens them up to consequences if they deny in that scenario.
I love asking the mercenary peer review doctor if he can’t read or doesn’t know his employer’s criteria for the procedure I am requesting. There’s usually just silence, then a quick it’s approved before they hang up. I am infinitely annoyed that I have to justify appropriate medical care, but I take pleasure in getting approval regardless…