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
Are New Employees Covered by Self Insurance Coverage? Read More »
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
$85,000 Pre-authorized Medical Bill Denied Read More »
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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I had a recent case where this person went from a rehab to a hospital and back to another rehab. Again, this was a case where the commercial insurers are throwing people outta rehabs due to their limited time period of coverage. Everyone has. Everyone who has an advantage plan for Medicare is continuously thrown
Thrown Out of Rehab While on Medicare Read More »
You get stung by a bee and you have difficulty breathing. You got swelling of your throat or tongue, you got a rapid pulse, you are dizzy or fainting. Please go directly to the emergency room. I had a case recently where the emergency room wasn’t paid and the insurance company believed that the condition
Bee Sting Leads to Emergency Room Bill Not Covered by Insurance Read More »
It’s easy to confuse titles, but the roles are different—and so are their loyalties. Q: Is a health insurance advocate the same as a broker? A: No. A broker helps you select a plan, while an advocate helps you use the plan you already have. Q: What about a hospital case manager? A: They assist
Why You Need a Health Insurance Advocate Right Now Read More »