One of the issues I hear so much is people have no idea how to challenge a bill. I worked for two insurance companies that not only taught me all the steps on how to deny a claim, but I learned how to challenge a bill, handle appeals, and either overturn the cases or minimize […]
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Hospital price transparency helps Americans know the cost of a hospital item or service before receiving it. Starting January 1st, 2021, each hospital operating in the United States was required to provide clear, accessible pricing information online about the items and services they promote in two ways. The first was as a comprehensive machine-readable file
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When faced with high out-of-pocket costs, healthier individuals might opt out of necessary healthcare to avoid expenses, a behavior that insurers indirectly encouraged. This leads to a cycle of rising premiums and decreasing access to care. This is what is titled Adverse selection. What I see all too often is young people think, no worries. I am
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A case recently involved my client being in a hospital for emergency brain tumor surgery. They had a policy through the Affordable Care Act in New York State, and I could not believe that they were denying the claims. It took about 10 months to cover to turn the case over, but finally, the bill
Denied Medical Claim While on Health Marketplace Read More »
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
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Navigating the murky waters of the healthcare system can feel like you’re drowning. The debate over a patient advocate vs medical billing advocate is more than semantics; it’s about choosing the right champion for your specific battle. You’re facing a mountain of incomprehensible paperwork, cryptic denial letters from your insurer, and bills that read like
Patient Advocate vs Medical Billing Advocate: Read This First 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
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A hospital billing advocate is a professional who assists patients in reviewing, understanding, and negotiating medical bills to ensure accuracy and fairness. By leveraging their expertise, these advocates help patients navigate the complexities of hospital billing, potentially saving them significant amounts of money and reducing stress. What Is a Hospital Billing Advocate? A hospital billing
Hospital Billing Advocate Secrets Doctors Don’t Tell You 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 »
In today’s intricate healthcare landscape, patients often find themselves overwhelmed by medical jargon, insurance complexities, and administrative hurdles. To effectively manage these challenges, many individuals choose to hire a medical billing advocate. These professionals serve as dedicated allies, guiding patients through the healthcare system to ensure they receive appropriate care and support. Understanding the Role
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