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 […]
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Negotiating medical bills effectively can mean the difference between paying an inflated balance and resolving a denied claim for a fair, manageable amount. A denial can feel final, especially when collection notices arrive or the provider insists the full balance is your responsibility. But billing errors, coding problems, missing documentation, authorization disputes, and insurance processing
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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
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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
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Filing complaints against providers/insurers can become an important step when denied medical claims, billing disputes, or unfair insurance practices leave patients overwhelmed and financially vulnerable. Across the United States, many people feel powerless after repeated denials, unanswered calls, or confusing medical bills that never seem to get resolved. That frustration can quickly turn into fear.
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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
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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
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Medical debt collection laws can affect everything from collection calls to credit reporting after denied medical claims and unpaid healthcare bills. Across the United States, many patients feel trapped between health insurance denials, rising balances, and aggressive collection notices without fully understanding the legal protections that may still exist. That pressure can escalate quickly. A
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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
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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
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