The best way to protect yourself against a denial is to get pre-approval for medical services from your insurer in non-emergency situations. If it is an emergency, it is truly the responsibility of the medical provider to obtain the pre-authorization. Even if your provider is planning to perform surgery on you, it is their responsibility. I recently
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Surgical billing complexity can turn one medical procedure into several bills, conflicting insurance decisions, and a balance that is difficult to verify. A denial may make it appear that you owe every charge from the hospital, surgeon, anesthesiologist, laboratory, and imaging provider. But one coding problem, authorization dispute, network mistake, or missing document can ripple
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Some of the best advice I can provide is to shop carefully for the right insurance policy that offers comprehensive coverage from medical providers with a good reputation. With Medicare Advantage plans, this has been a major issue. Some of the best hospitals and doctors will not credential for a Medicare Advantage plan because they often
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If you’ve had a denied claim appeal, be prepared to provide documentation. It’s important to have a doctor write a letter explaining why the procedure was performed and why it was medically necessary for you. The letter should also explain what could have happened if you had not had the procedure. I recently overturned a case that
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Emergency room billing disputes can involve thousands of dollars, multiple providers, and an insurance denial that makes the entire balance appear to be your responsibility. The bill may feel impossible to challenge because the care already happened and there was no time to compare prices or networks. Yet emergency claims can be denied incorrectly, processed
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It’s so important to have health insurance. According to the No Surprises Act, you are generally protected from balance billing for emergency services and for non-emergency services received at an in-network facility from out-of-network providers. You are only responsible for your in-network cost-sharing. So please remember that. Because of the No Surprises Act, if it’s an
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So you have an emergency, but the insurance company is claiming that it wasn’t medically necessary. This is their retaliation to the No Surprises Act, which was passed January 2022. The health insurance companies are now claiming that many ambulance trips are not needed. In fact, the National Association of EMS, emergency medical physicians, they have been warned
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Hospital billing advocacy can help you determine whether a denied medical claim should be corrected, appealed, reduced, or paid before the balance moves deeper into collections. A hospital statement can look final even when it contains coding problems, missing insurance adjustments, duplicate charges, or an unresolved coverage issue. Paying too quickly may close off opportunities
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I hope I helped you with some information today. When it comes to college insurance, premiums may be included in tuition, but loan interest can still be high. Specialized care can be expensive, especially if it’s off-campus, and many plans may end during academic breaks or after graduation. It’s important to read the policy carefully to
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I’m here to help you with all issues related to medical bills. Medical Insurance Advocacy, my company, helps you navigate the system, review medical records, and negotiate with providers and health insurance companies. I’ve been in the health insurance industry for 35 years and have been very successful in overturning cases. I was recently featured on Fox News
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