If your dispute was decided in your favor, but the provider is still billing you or has even sent your bill to collections, I highly recommend you reach out to MedWize, my company. We will review your situation and let you know what the next steps should be. A case like this happened recently, where I saved […]
Saved Over $13,000 With This Read More »
I hope you’re having a fantastic afternoon. Eighty percent of medical claims are incorrect. There are often errors where procedures appear on your bill that never occurred, or you might find duplicate charges or incorrect charges. Please contact me if this happens to you. I recently had a case where a client was being billed $9,000, and
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Have you ever gone to the doctor, submitted your claim, and got a letter saying your insurance won’t pay? That is a denial. It means your insurer has rejected the claim, either for a service they say isn’t covered or for some other reason. It doesn’t always mean you’re stuck with the bill, but it does mean
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Why do claims get denied? The most common reasons include missing information, incorrect billing codes, lack of pre-authorization, or service being out of network. Sometimes, the insurer simply doesn’t believe the service was medically necessary. Knowing these reasons can help you spot errors and avoid denials before they even happen. Please call me. I’m here to
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The No Surprises Act prevents surprise bills for emergency services, even if received from an out-of-network provider or facility. It limits out-of-network cost-sharing for non-emergency services received at an in-network facility, such as hospitals or ambulatory surgical centers. It also prohibits balance billing for air ambulance services, even if they are out-of-network. Please call me. I’m here
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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
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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
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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.
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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
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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
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