Understanding CPT, ICD-10, and HCPCS codes can be the difference between a paid claim and a denied one—and most people don’t even know these codes exist until something goes wrong. You open a bill that makes no sense. Then comes the denial. You call your insurance, but the explanation sounds like another language. That’s because,
Understanding CPT, ICD-10, and HCPCS Codes Read More »
If you come across an unfair medical bill, the first thing you need to do is examine your insurance coverage. Review your plan, understand your deductibles, your co-pays, your co-insurance, and out-of-pocket maximum. I very often overturn cases by proving the policy covers for specific types of procedures. I recently had a case involving infertility and was
Infertility Bill Claims Unpaid? Read More »
The No Surprises Act became effective January 1st of 2022, and it protects consumers from surprise medical bills for emergency services and non-emergency services. It limits out-of-network cost-sharing and establishes a dispute resolution process for billing disagreements. This includes protections for uninsured and self-pay individuals who can request a good faith estimate of medical costs and
No Surprises Act Explained Read More »
How the U.S. healthcare payment system works isn’t just confusing—it’s the reason so many people end up stuck with overwhelming healthcare bills and denied medical claims they don’t understand. You did everything right. You went to the doctor, followed instructions, and trusted your insurance. Then the bill came… or worse, a denial letter. Suddenly, you’re
How the U.S. Healthcare Payment System Works Read More »
One of the major issues causing high premiums on our pharmaceutical drugs is due to research and development. The question is: why are drug prices lower in other countries? Outside the US, the countries pay for the manufacturing cost of the drug and a very small profit on the cost of manufacturing. But here in the United States,
Why Drug Prices Are Cheaper in Other Countries Read More »
Are you now appealing an ERISA claim denial? What was the reason for your denial? Very often, the State Department of Insurance and the attorney general for your state will not assist you with your appeal. You need to find out which Department of Labor to reach out to. Once you have that information, send your appeal to that
Erisa Claim Denial? Read More »
The difference between Medical Billing advocate, coder, and biller can mean the difference between paying thousands—or paying nothing—when your claim gets denied. Most people don’t realize they’re calling the wrong professional until it’s too late. If you’ve ever opened a shocking bill or received a denial letter, you already know how fast confusion turns into
Medical Billing Advocate vs Coder vs Biller Explained Read More »
I hope you’re having a fantastic day. I was reading an article recently that said, “The devil is in the details.” But you know what? The strength is in the essentials. Our healthcare system is complicated, and you don’t want to be caught off guard or taken advantage of. Many people call me to help them evaluate
Why America’s Health Care System is Sick Read More »
Artificial intelligence is changing many parts of the insurance industry, and unfortunately, some people feel they are not receiving the treatment they need because of automated claim decisions. If you’re having problems getting approval for care, or if your claims are being denied, please call MedWise. I’m here to help you navigate the process and advocate
Is AI Causing More Medical Claim Denials? Read More »
Understanding how do insurance companies use diagnosis codes can help you prevent denials, reduce medical debt, and protect your financial future. Many patients are surprised to learn that one small coding detail can determine whether a claim is approved or rejected. The good news is that once you understand this process, you gain leverage and
Why Coding Errors Cause Medical Claim Rejections and How to Fix Them Read More »