Patients with multiple insurance coverage, such as Medicare and a supplemental plan or dual commercial plans, often face issues when their bills are sent to the wrong payer or processed in the incorrect order. This can lead to a denial, leaving the patient responsible for a full balance until the issue is resolved. For example,
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Pediatric billing advocacy can become critical when your child receives necessary medical care but the insurance company denies the claim, leaving you confused about what happened and what you may owe. When you are already focused on your child’s health, fighting with insurance can feel like a second emergency. Before assuming the bill is correct,
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Mental health billing challenges can interrupt treatment, create unexpected debt, and leave patients wondering whether their insurance company applied the same standards it uses for physical healthcare. A denial may arrive while therapy, psychiatric care, medication management, or substance-use treatment is still urgently needed. Paying immediately may feel like the easiest path, but the claim
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Too often when denials occur, we have to go through multiple appeals to resolve the issue. I often ask for help from the media because, many times, that is the only way the insurance company pays the claim. Last summer, I was published in NJ.com, and the article came out in September 2024 about a $25,000 denial
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The best way to protect yourself against a denial is to get pre-approval for medical services from your insurer in non-emergency situations. If it is an emergency, it is truly the responsibility of the medical provider to obtain the pre-authorization. Even if your provider is planning to perform surgery on you, it is their responsibility. I recently
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Surgical billing complexity can turn one medical procedure into several bills, conflicting insurance decisions, and a balance that is difficult to verify. A denial may make it appear that you owe every charge from the hospital, surgeon, anesthesiologist, laboratory, and imaging provider. But one coding problem, authorization dispute, network mistake, or missing document can ripple
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A medical provider has to give you a good faith estimate of your costs before you receive services, and you can dispute a bill if it is significantly higher than that estimate. I recently had a case where a dentist told my client the bill would be $8,000, but they were actually charged $22,000. By referencing
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Here are different reasons you can dispute a bill. You can dispute a bill if you received care and did not have or did not use your health insurance to pay for it. You can also dispute it if, before receiving care, you told the provider you would not be using insurance. Another situation is if you
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The No Surprises Act has been helpful in overturning cases and reducing fees when a patient is responsible for part of a bill. It provides protection against surprise bills from out-of-network providers or facilities. I recently handled a case where a client went to the emergency room and, after being denied three times, I reduced the bill
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Charity care qualification could reduce or eliminate a hospital bill, even when you have health insurance and the insurance company denied your claim. A denial can make the hospital’s full balance feel immediate and unavoidable. You may be urged to begin payments, use a medical credit card, or accept responsibility before anyone explains your financial-assistance
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