In a conversation between Edison Guzman and Adria Gross of MedWise Insurance Advocacy, they discuss the significant impact of who processes medical bills. Adria highlights that when third-party billing companies handle claims, especially those paid on a percentage basis (a common practice outside of states like New York), it becomes exceedingly difficult for patients to get discounts for overbilling, as these companies are incentivized to maximize collections.

This often forces patients to appeal directly to the medical provider, who may be uncooperative. Further complications arise when these billing services, sometimes located overseas, fail to process claims with secondary or tertiary insurance, leaving patients to manage the follow-up or providers to accept reduced payments. Adria also notes issues with timely claim submissions, particularly with out-of-network providers, and emphasizes that understanding and navigating these billing intricacies is crucial, offering her expertise to help individuals facing such challenges.