I hope you’re having a fabulous day today. It is so difficult to fight for coverages when your company is so large and they have a self-funded, self-insured or risk plan. Many employers do not want to pay large claims for recent hired employees unless they are so well liked that the employer is willing […]
Are New Employees Covered by Self Insurance Coverage? Read More »
I recently had a case where surgery was required. None of the in-network providers were able to perform the services. It took four months, but we were finally able to get a single case agreement with an out of network provider, and the insurance company finally agreed to pay the in-network fees. If you ever
Out of Network Providers Can Still be Paid by Insurance Read More »
One of my recent clients was informed the provider was in network. They went for the surgery and later found out that the provider was really out of network and they were never covered. The fact that they were misinformed, I was able to get the bill from $29,000 down to zero due to their
Misinformed About What Medical Insurance Covers Read More »
Good afternoon, my friends, one of my clients had a pre-authorization for radiation due to rectal cancer. The bills were over $85,000, and even though she had pre-authorization, the insurance company did not want to pay it. Since the hospital at the time was out of network. The fact that there was pre-authorization, even though
$85,000 Pre-authorized Medical Bill Denied Read More »
I had a recent case where my client wound up in a rehab for drugs and alcohol. They told my client that they would be at this facility for two weeks and believe it or not, they were demanding $70,000. That means the cost was $35, $35,000 per week. I could not believe that prior
Rehab for Drugs and Alcohol $70,000 Bill Denied Read More »
I have to tell you this story. You have a traumatic brain injury and you wind up being in a coma for two months. Your commercial insurer informs your family that you will. They will definitely cover you, but after you leave the facility, you get a bill for over $300,000, which the provider claims
Coma Patient with a $300,000 CoPay? Read More »
Understanding the differences between hospital-based billing and professional billing is crucial for patients navigating the complex healthcare system. These billing methods can significantly impact your medical expenses and how services are charged. Unpacking Hospital-Based Billing Hospital-based billing, also known as institutional billing, pertains to charges incurred for services provided within a hospital setting. This includes
Why Hospital Based Billing vs Professional Billing Matters Read More »
You know, Medicare Advantage is often touted as as beneficial, but most people believe it to be a scam. It’s particularly, particularly harmful to those with severe health issues. These plans often deny necessary care and delay treatments, jeopardizing patient health. Ultimately, the United States healthcare system’s reliance on private insurers and their administrative complexities
The Colonoscopy That Was Almost Not Covered Read More »
I hope this never happens to you. You have a really bad injury to your big toe. You go to a podiatrist who explains to you that the bill should be no more than $2,000. You go home and what do you do? You get a bill in the mail for 6,500, not 2000. I
$6,000 Podiatry Bill Reduced to $750 Read More »
I recently had a phone call involving a person who fell down two flights of stairs. They had 25 stitches in their head. The case involved a hospital in California, and after entering through the emergency room, the insurer felt it was not medically necessary for her to be at the hospital. The bills were
ER Medical Bill Not Medical Necessary? Read More »