Medical Bill Advocate

Many health insurers require a review of claims or prior authorization requests by a nurse and a doctor, both employed by the insurer. Recent media investigations have found that some insurance company doctors are not incentivized to spend the time needed to scrutinize patients’ medical records and follow guidelines for making informed decisions about approving

Hospital upcoding, which is claiming a higher level of patient severity in order to obtain a higher insurance payment, is a major issue. One study estimates that increased upcoding relative to a decade earlier was associated with $14.6 billion in hospital payments. I have people calling me about this, where they feel that they were

You know Americans are sick of the health insurance companies who steal our money and our lives. The more profits that the insurance companies make, the more extra cash is available to distribute to shareholders as dividends and buybacks, and generally the higher the stock price, the greater the potential for higher top executive pay.

An illness can destroy an entire family, leaving them bankrupt and homeless, with the repercussions of that sudden fall into poverty echoing down through generations. Most Americans have no idea that the US is quite literally the only country in the developed world that doesn’t define healthcare as an absolute right for all of its

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

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

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

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

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