The No Surprises Act became effective January 1st of 2022, and it protects consumers from surprise medical bills for emergency services and non-emergency services. It limits out-of-network cost-sharing and establishes a dispute resolution process for billing disagreements. This includes protections for uninsured and self-pay individuals who can request a good faith estimate of medical costs and […]
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One of the major issues causing high premiums on our pharmaceutical drugs is due to research and development. The question is: why are drug prices lower in other countries? Outside the US, the countries pay for the manufacturing cost of the drug and a very small profit on the cost of manufacturing. But here in the United States,
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Are you now appealing an ERISA claim denial? What was the reason for your denial? Very often, the State Department of Insurance and the attorney general for your state will not assist you with your appeal. You need to find out which Department of Labor to reach out to. Once you have that information, send your appeal to that
Erisa Claim Denial? Read More »
I hope you’re having a fantastic day. I was reading an article recently that said, “The devil is in the details.” But you know what? The strength is in the essentials. Our healthcare system is complicated, and you don’t want to be caught off guard or taken advantage of. Many people call me to help them evaluate
Why America’s Health Care System is Sick Read More »
Artificial intelligence is changing many parts of the insurance industry, and unfortunately, some people feel they are not receiving the treatment they need because of automated claim decisions. If you’re having problems getting approval for care, or if your claims are being denied, please call MedWise. I’m here to help you navigate the process and advocate
Is AI Causing More Medical Claim Denials? Read More »
When you go onto a website to purchase health insurance, please make sure you take a close look at the policy and understand exactly what it covers and what it does not cover. You might be purchasing a plan that will not cover your specific condition, or your medical providers may not be in the
Do This Before You Purchase Any Medical Insurance Policy Read More »
Congress is currently scrutinizing Medicare Advantage plans. I had a new case this week where a patient was being discharged from the hospital because of issues with her insurance coverage. She was having complications with her pacemaker, and the insurance company initially would not authorize a visit with her cardiologist. When I received the call, I
Medicare Advantage Plan Refuses Care Read More »
I hope you’re having a fantastic day. When I started in the health insurance industry in the claims department, I became a claims supervisor within a short time. During my training, I learned very quickly how companies approach denying claims. It shouldn’t be driven by shareholder interests when people’s health and financial stability are at stake. Unfortunately,
A $32,000 Medical Claim Overturned Read More »
I hope your day is going great. When it comes to medical bills being denied by your insurance company, the numbers are staggering. According to the Kaiser Family Foundation, we now have over $220 billion in medical debt, and about 25% of people who need treatment simply can’t afford it. Fortunately, some nonprofit hospitals offer financial assistance
How Non-Profit Hospitals Help With Health Care Read More »
Good afternoon. I spoke with a client the other day who lives in Texas. He has a dental policy, and believe it or not, he was denied coverage for a routine teeth cleaning. Can you imagine being told it’s not medically necessary to clean your teeth? If you need assistance with any of your claim denials, please
Did Your Dental Coverage Deny Your Cleaning Bill? Read More »