The Affordable Care Act (ACA) granted people the right to appeal decisions made by their health insurers regardless of their insurance type or state of residence. The law also established rules for how insurance companies should handle initial appeals and allows insurers to request a reconsideration of decisions to deny payment. If an insurer upholds […]
How the ACA Works for Claim Denials Read More »
Insurers are motivated to avoid paying for care. Many insurers appear to be utilizing increasingly aggressive tactics to do so, deploying technology and applying pressure to company physicians to scrutinize services recommended by patients’ physicians, and often to deny coverage, leaving patients with unexpected bills or delays in care. You need care, and if you’re
Are Insurers Deliberately Denying Claims Read More »
Hello my friends. What service do private insurers provide in return for the fees they collect? Again, what service do private insurers provide in return for the fees that they collect? You may not realize the extent to which the insurance companies are exposing themselves to the delay and deny strategies. Private insurance is often
What Service Do Private Insurance Companies Provide Read More »
The lack of health coverage produces negative consequences. For instance, an individual avoiding upfront medical costs might end up in the emergency room where treatment is much more expensive. This not only increases healthcare costs for everyone but also places a heavier load on public resources and spreads illness. Make sure you have a good
What Increases Medical Care Costs Read More »
You know, over the years I have found that nearly half of respondents who experienced a delay in care following a coverage denial said that their health problems got worse as a result of those delays. Worry and anxiety among those experiencing delays are really universal. Nearly one in six reported cases indicate that care
Delay of Care Due to Care Denials Read More »
Many health insurers require a review of claims or prior authorization requests by a nurse and a doctor, both employed by the insurer. Recent media investigations have found that some insurance company doctors are not incentivized to spend the time needed to scrutinize patients’ medical records and follow guidelines for making informed decisions about approving
Unfair Review of Claims for Medical Bills Read More »
A fee-for-service medical cost arrangement exists in the United States. The more services doctors perform, the higher their incomes. Just as patients have an incentive to overconsume, doctors have an incentive to overprovide. If you’re having difficulties paying your medical bills, call me. I’m the owner of Medwise. We save individuals thousands of dollars on
Incentives for Over Providing Services Read More »
I hope you’re having a great day. Think about people’s billing disputes and denials of coverage. What emerges is that many realize positive outcomes when they appeal decisions they perceive to be in error. Yet only half of those who believe that they were erroneously billed or denied care actually challenge the decision or have
Billing Disputes and Denials of Medical Coverage Read More »
I hope you’re having a fantastic day. The responsibility of appealing may not be clear between the patients, the providers, or between the employers and the employees, and the documentation requirements to appeal can create additional barriers. As a beneficiary, you have a right to appeal your insurer’s decision. Due to artificial intelligence, all too
Who’s Responsible for the Medical Appeal Process? Read More »
Hospital upcoding, which is claiming a higher level of patient severity in order to obtain a higher insurance payment, is a major issue. One study estimates that increased upcoding relative to a decade earlier was associated with $14.6 billion in hospital payments. I have people calling me about this, where they feel that they were
What is Hospital Upcoding Read More »