If You’re Appealing a Case-Do This
If you’re appealing a case and you, your healthcare provider, or the facility can settle the payment amount before the dispute ends, you can move forward if both parties agree to a reduced bill or to pay the agreed amount in full. If you and your provider or facility reach an agreement, be sure to notify […]
How Your Insurance Works with the No Surprise Act
Your insurer may have decided not to pay part or all of your claim. If you think this decision violates the No Surprises Act, appeal your bill. Follow the process described in your health insurance plan’s documents and the denial notices. Learn more about your rights under the No Surprises Act. If you receive a bill and have […]
Why Ask for an Itemized Bill When Denied Medical Claim
If you receive a balance bill or believe you are overcharged, request an itemized bill and dispute the charges. Ask the provider or hospital for an itemized bill with all billing codes listed. Your billing codes should be five-digit procedure codes. Make sure you’re not relying on a hospital bill that only shows three to five numbers or […]
Saved Over $13,000 With This
If your dispute was decided in your favor, but the provider is still billing you or has even sent your bill to collections, I highly recommend you reach out to MedWize, my company. We will review your situation and let you know what the next steps should be. A case like this happened recently, where I saved […]
How I Had a $9,000 Medical Bill Written Off
I hope you’re having a fantastic afternoon. Eighty percent of medical claims are incorrect. There are often errors where procedures appear on your bill that never occurred, or you might find duplicate charges or incorrect charges. Please contact me if this happens to you. I recently had a case where a client was being billed $9,000, and […]
What is an Insurance Claim Denial?
Have you ever gone to the doctor, submitted your claim, and got a letter saying your insurance won’t pay? That is a denial. It means your insurer has rejected the claim, either for a service they say isn’t covered or for some other reason. It doesn’t always mean you’re stuck with the bill, but it does mean […]
The Most Common Reasons for Denied Medical Bill Claims
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 […]
Out of Network Air Ambulance Services
The No Surprises Act prevents surprise bills for emergency services, even if received from an out-of-network provider or facility. It limits out-of-network cost-sharing for non-emergency services received at an in-network facility, such as hospitals or ambulatory surgical centers. It also prohibits balance billing for air ambulance services, even if they are out-of-network. Please call me. I’m here […]
A $54,000 Medical Bill Written Off After Denial
When a provider considers your procedure to be necessary and the insurance company says, “Hey, it wasn’t medically necessary,” you have to fight to make sure that the insurer does not pass the cost to you. If you can prove that it was medically necessary, your denied claim should be paid. I recently had a case where […]
Confused by Insurance Jargon
Denial letters are full of insurance jargon, but don’t let that intimidate you. Look for the reason for the denial. It’s usually listed by a code. And check your explanation of benefits, your EOB, it’s called. You have to understand the exact reason, which will help you determine your next steps, whether it’s correcting an error, appealing a […]