When a provider considers your procedure to be necessary and the insurance company says, “Hey, it wasn’t medically necessary,” you have to fight to make sure that the insurer does not pass the cost to you. If you can prove that it was medically necessary, your denied claim should be paid. I recently had a case where […]
A $54,000 Medical Bill Written Off After Denial Read More »
Denial letters are full of insurance jargon, but don’t let that intimidate you. Look for the reason for the denial. It’s usually listed by a code. And check your explanation of benefits, your EOB, it’s called. You have to understand the exact reason, which will help you determine your next steps, whether it’s correcting an error, appealing a
Confused by Insurance Jargon Read More »
Getting denied isn’t the end of the road. You have the right to appeal. That means asking the insurer to reconsider the decision. Start by calling the insurer to understand the denial. Then submit an appeal, usually in writing, with all the supporting documents. Be polite, clear, and timely. You would be surprised how many denials are overturned.
Getting Denied Is Not the End Read More »
Many services require pre-authorization from your insurance company. That means your doctor has to get approval before doing a test or procedure. If that doesn’t happen, your claim could be denied, even if you really needed that care. Always ask if your service needs pre-approval to avoid unexpected bills. I recommend you get the approval in writing from your
Why You Always Want a Pre Approval Letter Read More »
Don’t wait if you’ve been denied. Lost insurance plans give you 120 days, or about six months, to file an appeal. Direct Medicare is 12 months. It used to be 24 months, now only 12. And some plans allow you even less time than 120 days. Mark your calendar, keep records, and act quickly. Missing the deadline
How Long Do You Have to File An Appeal Read More »
Students in college are normally able to purchase health insurance through their university. I’ve handled many cases involving college health insurance. I must say, the health carriers are very suspicious when the students are submitting claims, and very often, the college student, with each and every claim, has to prove that they are the insured. I couldn’t believe
College Students Must Prove What? Read More »
Filing complaints against providers/insurers can become an important step when denied medical claims, billing disputes, or unfair insurance practices leave patients overwhelmed and financially vulnerable. Across the United States, many people feel powerless after repeated denials, unanswered calls, or confusing medical bills that never seem to get resolved. That frustration can quickly turn into fear.
Filing Complaints Against Providers/Insurers After Denied Claims Read More »
Recently, several Medicare Advantage plans have exited the market, including Premera and the Blue Cross Blue Shield of Kansas City. Also, others have reduced their service areas, such as Aetna and Humana. Prior to the annual enrollment period in 2024, many for-profit health plans signaled their intent to slow growth or even contract membership due to
Having Medicare Advantage Plan Issues Read More »
Okay, you have received pre-authorization for appendicitis. You undergo the surgery, but now your insurance carrier, who approved the surgery, says it wasn’t medically necessary. The bills were over $30,000. I’m asked to help my client with their bills. It took quite a few months, but I was able to get the claim paid. These are just a
Why Patient Insurance Oversight is Necessary Read More »
Medical debt collection laws can affect everything from collection calls to credit reporting after denied medical claims and unpaid healthcare bills. Across the United States, many patients feel trapped between health insurance denials, rising balances, and aggressive collection notices without fully understanding the legal protections that may still exist. That pressure can escalate quickly. A
Medical Debt Collection Laws and Your Patient Rights Read More »