Filing Complaints Against Providers/Insurers After Denied Claims
Filing complaints against providers/insurers can become an important step when denied medical claims, billing disputes, or unfair insurance practices leave patients overwhelmed and financially vulnerable. Across the United States, many people feel powerless after repeated denials, unanswered calls, or confusing medical bills that never seem to get resolved. That frustration can quickly turn into fear. […]
Having Medicare Advantage Plan Issues
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 […]
Why Patient Insurance Oversight is Necessary
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 […]
Medical Debt Collection Laws and Your Patient Rights
Medical debt collection laws can affect everything from collection calls to credit reporting after denied medical claims and unpaid healthcare bills. Across the United States, many patients feel trapped between health insurance denials, rising balances, and aggressive collection notices without fully understanding the legal protections that may still exist. That pressure can escalate quickly. A […]
Is Your Insurance Plan Fully Funded?
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 […]
Why a Letter of Medical Necessity May Save You Thousands
Medical claims that require pre-approvals or claims involving newly developed drugs or treatment, and many types of behavioral health treatment may require a letter of medical necessity from the treating doctor before the claim is approved. Claimants should be aware that their physicians are ready and willing to back up their claims. You do not want to […]
State vs Federal Regulations for Health Insurance Claims
State vs federal regulations can dramatically affect how denied medical claims, insurance appeals, billing protections, and patient rights are handled across the United States. Many patients assume all health insurance rules operate under one unified system, only to discover that state laws and federal laws sometimes overlap, conflict, or apply differently depending on the insurance […]
$26,500 Claim Paid for This Reason
A recent case that I worked on involved a medical bill denial for $26,500. Believe it or not, the insurance carrier made an error thinking it was a totally different policy that doesn’t cover for pregnancy. I was so happy to realize their error and have their claim paid. If you need help, please call me. Thank you. […]
Is AI Automatically Denying Your Medical Claims
Too often the medical claims are denied when your insurance carrier’s AI, artificial intelligence, looks at the diagnosis and medical procedures on your submitted medical bill and they decide to deny it. MedWise is passionate about helping those facing wrongful denials and coverage issues. This is happening right now at a high percentage of submitted claims. I […]
HIPAA Privacy Rules Explained for Insurance Claims and Appeals
HIPAA privacy rules explained in simple terms can help patients protect their medical information while navigating denied medical claims, health insurance disputes, and complex billing situations. Across the United States, many people feel confused about what healthcare providers, insurance companies, and third parties are legally allowed to access or share. That confusion often becomes even […]