The Best Chance You’ll Have at Overturning Your Case
You are now about to dispute a bill which you received from a collection agency. You need to request verification from the agency, and I recommend you submit a complaint to the Consumer Financial Protection Bureau and the Centers for Medicare and Medicaid Services. By making a complaint with those departments and/or hiring a medical […]
Understanding CPT, ICD-10, and HCPCS Codes
Understanding CPT, ICD-10, and HCPCS codes can be the difference between a paid claim and a denied one—and most people don’t even know these codes exist until something goes wrong. You open a bill that makes no sense. Then comes the denial. You call your insurance, but the explanation sounds like another language. That’s because, […]
Infertility Bill Claims Unpaid?
If you come across an unfair medical bill, the first thing you need to do is examine your insurance coverage. Review your plan, understand your deductibles, your co-pays, your co-insurance, and out-of-pocket maximum. I very often overturn cases by proving the policy covers for specific types of procedures. I recently had a case involving infertility […]
No Surprises Act Explained
The No Surprises Act became effective January 1st of 2022, and it protects consumers from surprise medical bills for emergency services and non-emergency services. It limits out-of-network cost-sharing and establishes a dispute resolution process for billing disagreements. This includes protections for uninsured and self-pay individuals who can request a good faith estimate of medical costs […]
How the U.S. Healthcare Payment System Works
How the U.S. healthcare payment system works isn’t just confusing—it’s the reason so many people end up stuck with overwhelming healthcare bills and denied medical claims they don’t understand. You did everything right. You went to the doctor, followed instructions, and trusted your insurance. Then the bill came… or worse, a denial letter. Suddenly, you’re […]
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 […]