Why America’s Health Care System is Sick
I hope you’re having a fantastic day. I was reading an article recently that said, “The devil is in the details.” But you know what? The strength is in the essentials. Our healthcare system is complicated, and you don’t want to be caught off guard or taken advantage of. Many people call me to help them evaluate […]
Is AI Causing More Medical Claim Denials?
Artificial intelligence is changing many parts of the insurance industry, and unfortunately, some people feel they are not receiving the treatment they need because of automated claim decisions. If you’re having problems getting approval for care, or if your claims are being denied, please call MedWise. I’m here to help you navigate the process and advocate […]
Do This Before You Purchase Any Medical Insurance Policy
When you go onto a website to purchase health insurance, please make sure you take a close look at the policy and understand exactly what it covers and what it does not cover. You might be purchasing a plan that will not cover your specific condition, or your medical providers may not be in the […]
Medicare Advantage Plan Refuses Care
Congress is currently scrutinizing Medicare Advantage plans. I had a new case this week where a patient was being discharged from the hospital because of issues with her insurance coverage. She was having complications with her pacemaker, and the insurance company initially would not authorize a visit with her cardiologist. When I received the call, I […]
A $32,000 Medical Claim Overturned
I hope you’re having a fantastic day. When I started in the health insurance industry in the claims department, I became a claims supervisor within a short time. During my training, I learned very quickly how companies approach denying claims. It shouldn’t be driven by shareholder interests when people’s health and financial stability are at stake. Unfortunately, […]
How Non-Profit Hospitals Help With Health Care
I hope your day is going great. When it comes to medical bills being denied by your insurance company, the numbers are staggering. According to the Kaiser Family Foundation, we now have over $220 billion in medical debt, and about 25% of people who need treatment simply can’t afford it. Fortunately, some nonprofit hospitals offer financial assistance […]
Did Your Dental Coverage Deny Your Cleaning Bill?
Good afternoon. I spoke with a client the other day who lives in Texas. He has a dental policy, and believe it or not, he was denied coverage for a routine teeth cleaning. Can you imagine being told it’s not medically necessary to clean your teeth? If you need assistance with any of your claim denials, please […]
Is AI Automatically Denying Claims for Autistic Children?
You know, I’ve been absolutely shocked that some companies are limiting treatment for autistic children. There was a recent case where the New York State Attorney General forced an insurance carrier to pay a $1 million penalty for failing to provide proper coverage. What has been happening is that some insurance companies are denying claims to […]
Medical Claim Was Denied for This Reason
I hope you’re having a fabulous day. You know, 99% of all enrollees who have a Medicare Advantage plan need to obtain prior authorization for many services. This most commonly applies to higher-cost treatments, including inpatient hospital stays, skilled nursing facility care, and chemotherapy. Medical providers are responsible for obtaining prior authorization. Patients should not be paying […]
The Challenge with Medicare Advantage Plans
I hope you’re having a fantastic day. I’ve always been shocked by what insurers get away with. When I went into the health insurance industry as a claims analyst, within two weeks the company taught me how to deny claims. This is why I’m here to help you. If your claim is denied, you’re overcharged out of […]