If you are interested in using a doctor who’s out of network, you need to be able to prove that nobody else is able to perform the surgery. Uh, and, and, and when we’re talking about the other people, you have to first look at your insurance, health insurance plan to see who’s listed who …
Here’s How an Out of Network Surgeon is Covered Under Your Insurance Read More »
Have you or anyone you know filed for disability? If you’re thinking about filing for disability,the most important thing is you need to be sure that you will be eligible.I recently had a case where my client had been on disability for over 10 years, and I was able to assist him to continue to …
If You’re Considering Filing for Disability, You Need to Hear This Read More »
I had a case where this young boy had emergency brain surgery. The surgeon was billing my client $186,000. The doctor was out of network. So, the family, was having major problems. The sad thing was that there was an ERISA plan with their employer. The ERISA plans are different. The employer makes up all …
Emergency Service for $186,000 Completely Covered with ERISA Plan Read More »
I’m working on a case that just came to me and the bill’s $144,000 and the client had no health insurance. He doesn’t have any health insurance at all. So very often when you approach the billing department for the medical provider, you will need to discuss the allowable amounts which are normally built because …
$144,000 Medical Bill Reduced With No Health Insurance Plan Read More »
I have to tell you right now I am receiving quite a few clients whose insurance company is saying it wasn’t medically necessary for you to be in the hospital, and you could have been there for two to seven evenings. You go to the emergency room, they admit you to the hospital, and they’re …
What if it Wasn’t Medical Necessary, But You’re Billed? Read More »
I don’t know if anybody heard about this, but January 1st, 2022, a new bill was passed. It’s called the No Surprise Act. It is a national, um, uh, act. Uh, and a doctor has no right to charge you for services if they didn’t tell you in advance that they were outta network and …
$25,000 Medical Fee Reduced to $1,700 Due to the No Surprise Act Read More »
if a provider does not have pre-authorization for services rendered, which are usually the following procedures, surgery when they’re, uh, doing a procedure and they have to put dye in you, MRI, CAT scan, and, and also involving many other services, your claim is going to be denied if you didn’t have pre-authorization. I recently …
Who’s Responsible for Preauthorization for Your Medical Procedure? Read More »
Believe it or not, some medical providers are still using outdated CPT or ICD nine codes. A C P T code is the procedure performed and the I C D nine codes are no longer in existence. Now they have these I C D 10 codes and the I C D is your diagnosis. The …
Have you ever been in a situation where your provider did not send the bill out to the insurance company on time? Insurance company usually demand that they receive the bills for services within 3, 4, 6, 9 or 12 months. So this client was directed and was billed over $75,000. When we discussed this …
What If Your Provider Does Not Send Out the Bill on Time to the Insurance Company? Read More »
If it’s possible, I highly recommend that you keep track of claims that you have received and paid. It’s always best not to pay your medical provider until you receive the explanation of benefits. Sometimes providers duplicate the bills and occasionally they’re paid twice. I had a case recently where they were paid by the …
MedWise Insurance Advocacy
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