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. […]
Getting Denied Is Not the End Read More »
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
Why You Always Want a Pre Approval Letter Read More »
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
How Long Do You Have to File An Appeal Read More »
Students in college are normally able to purchase health insurance through their university. I’ve handled many cases involving college health insurance. I must say, the health carriers are very suspicious when the students are submitting claims, and very often, the college student, with each and every claim, has to prove that they are the insured. I couldn’t believe
College Students Must Prove What? Read More »
Recently, several Medicare Advantage plans have exited the market, including Premera and the Blue Cross Blue Shield of Kansas City. Also, others have reduced their service areas, such as Aetna and Humana. Prior to the annual enrollment period in 2024, many for-profit health plans signaled their intent to slow growth or even contract membership due to
Having Medicare Advantage Plan Issues Read More »
Okay, you have received pre-authorization for appendicitis. You undergo the surgery, but now your insurance carrier, who approved the surgery, says it wasn’t medically necessary. The bills were over $30,000. I’m asked to help my client with their bills. It took quite a few months, but I was able to get the claim paid. These are just a
Why Patient Insurance Oversight is Necessary Read More »
One of the misconceptions people experience is whether your health insurance plan is a fully funded plan or if it’s an ERISA plan. This is usually important information that you need to be aware of. When appealing your case, the question is whether to appeal with your health insurance carrier or to go to the Department of
Is Your Insurance Plan Fully Funded? Read More »
Medical claims that require pre-approvals or claims involving newly developed drugs or treatment, and many types of behavioral health treatment may require a letter of medical necessity from the treating doctor before the claim is approved. Claimants should be aware that their physicians are ready and willing to back up their claims. You do not want to
Why a Letter of Medical Necessity May Save You Thousands Read More »
A recent case that I worked on involved a medical bill denial for $26,500. Believe it or not, the insurance carrier made an error thinking it was a totally different policy that doesn’t cover for pregnancy. I was so happy to realize their error and have their claim paid. If you need help, please call me. Thank you.
$26,500 Claim Paid for This Reason Read More »
Too often the medical claims are denied when your insurance carrier’s AI, artificial intelligence, looks at the diagnosis and medical procedures on your submitted medical bill and they decide to deny it. MedWise is passionate about helping those facing wrongful denials and coverage issues. This is happening right now at a high percentage of submitted claims. I
Is AI Automatically Denying Your Medical Claims Read More »