Why do claims get denied? The most common reasons include missing information, incorrect billing codes, lack of pre-authorization, or service being out of network. Sometimes, the insurer simply doesn’t believe the service was medically necessary. Knowing these reasons can help you spot errors and avoid denials before they even happen. Please call me. I’m here to
The Most Common Reasons for Denied Medical Bill Claims Read More »
Getting denied isn’t the end of the road. You have the right to appeal. That means asking the insurer to reconsider the decision. Start by calling the insurer to understand the denial. Then submit an appeal, usually in writing, with all the supporting documents. Be polite, clear, and timely. You would be surprised how many denials are overturned.
Getting Denied Is Not the End Read More »
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
Having Medicare Advantage Plan Issues Read More »
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
Why Patient Insurance Oversight is Necessary Read More »
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
Is Your Insurance Plan Fully Funded? Read More »
Your doctor recommends an MRI. Your insurance carrier will not provide pre-authorization. Call Medwise. We are here to get you the services you’re entitled to. Thank you. https://vimeo.com/1117099525?share=copy
Doctor Recommends an MRI? Read More »
The effectiveness of Adria Gross, patient advocate, stems from a perspective few others possess. When you’re facing a mountain of medical bills or a cold insurance denial, it feels like an unwinnable war against a faceless system. You need more than just a helper; you need a strategist who knows the enemy’s playbook because she
How Adria Gross Patient Advocate Beats Insurance Denials Read More »
You know, over the years I have found that nearly half of respondents who experienced a delay in care following a coverage denial said that their health problems got worse as a result of those delays. Worry and anxiety among those experiencing delays are really universal. Nearly one in six reported cases indicate that care
Delay of Care Due to Care Denials Read More »
When you know you have been billed much more than you should have, please call midwives. All too often people are taken advantage of on their medical bills. We recently decreased a bill from $1,200 down to $55. Remember, I’m here to help you. Thank you. https://vimeo.com/1117099552?share=copy
Was Your Medical Bill Much Higher Than it Should Have? Read More »
I recently had a phone call involving a person who fell down two flights of stairs. They had 25 stitches in their head. The case involved a hospital in California, and after entering through the emergency room, the insurer felt it was not medically necessary for her to be at the hospital. The bills were
ER Medical Bill Not Medical Necessary? Read More »