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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

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

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

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

Believe it or not, some medical providers are still using outdated CPT or ICD nine codes.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

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

I recently had a case where the provider did not have medical records for which they were billing the patient for. It was very difficult for them to not be able to find any medical records, even though they kept on billing my client over $25,000. So there was a lot of fighting back and

I have to tell you, you know, this is crazy out there. People do not realize when they’re, when they turn 65 and they think, oh, this is gonna be great. If I go on a Medicare Advantage plan, let me tell you, if you wind up in a rehab, it’s not great because they