Why Drug Prices Are Cheaper in Other Countries
One of the major issues causing high premiums on our pharmaceutical drugs is due to research and development. The question is: why are drug prices lower in other countries? Outside the US, the countries pay for the manufacturing cost of the drug and a very small profit on the cost of manufacturing. But here in […]
Erisa Claim Denial?
Are you now appealing an ERISA claim denial? What was the reason for your denial? Very often, the State Department of Insurance and the attorney general for your state will not assist you with your appeal. You need to find out which Department of Labor to reach out to. Once you have that information, send […]
Medical Billing Advocate vs Coder vs Biller Explained
The difference between Medical Billing advocate, coder, and biller can mean the difference between paying thousands—or paying nothing—when your claim gets denied. Most people don’t realize they’re calling the wrong professional until it’s too late. If you’ve ever opened a shocking bill or received a denial letter, you already know how fast confusion turns into […]
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 […]
Why Coding Errors Cause Medical Claim Rejections and How to Fix Them
Understanding how do insurance companies use diagnosis codes can help you prevent denials, reduce medical debt, and protect your financial future. Many patients are surprised to learn that one small coding detail can determine whether a claim is approved or rejected. The good news is that once you understand this process, you gain leverage and […]
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 […]
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 […]
Insurance Claim Documentation Checklist to Prevent Denials
Knowing the right documents for insurance claim approval can mean the difference between getting paid and facing thousands in unexpected medical debt. Many claims are denied not because the treatment wasn’t necessary, but because paperwork was incomplete or submitted incorrectly. The good news is that you can take control of this process. Denied claims often […]