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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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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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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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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A medical provider has to give you a good faith estimate of your costs before you receive services, and you can dispute a bill if it is significantly higher than that estimate. I recently had a case where a dentist told my client the bill would be $8,000, but they were actually charged $22,000. By referencing
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Here are different reasons you can dispute a bill. You can dispute a bill if you received care and did not have or did not use your health insurance to pay for it. You can also dispute it if, before receiving care, you told the provider you would not be using insurance. Another situation is if you
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The No Surprises Act has been helpful in overturning cases and reducing fees when a patient is responsible for part of a bill. It provides protection against surprise bills from out-of-network providers or facilities. I recently handled a case where a client went to the emergency room and, after being denied three times, I reduced the bill
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