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 […]
Cash Pay vs Insurance Pricing After a Claim Denial
Cash pay vs insurance pricing can create a startling result: the price for using health insurance may be higher than the amount offered to someone paying without insurance. That difference becomes especially painful when your claim is denied and the provider suddenly expects you to pay the full balance. Before paying, switching to cash pricing, […]
Getting Denied Is Not the End
Getting denied isn’t the end of the road. You have the right to appeal. That means asking the insurer to reconsider the decision. Start by calling the insurer to understand the denial. Then submit an appeal, usually in writing, with all the supporting documents. Be polite, clear, and timely. You would be surprised how many denials are overturned. […]
Why You Always Want a Pre Approval Letter
Many services require pre-authorization from your insurance company. That means your doctor has to get approval before doing a test or procedure. If that doesn’t happen, your claim could be denied, even if you really needed that care. Always ask if your service needs pre-approval to avoid unexpected bills. I recommend you get the approval in writing from your […]
Negotiating Medical Bills Effectively After a Denied Claim
Negotiating medical bills effectively can mean the difference between paying an inflated balance and resolving a denied claim for a fair, manageable amount. A denial can feel final, especially when collection notices arrive or the provider insists the full balance is your responsibility. But billing errors, coding problems, missing documentation, authorization disputes, and insurance processing […]
College Students Must Prove What?
Students in college are normally able to purchase health insurance through their university. I’ve handled many cases involving college health insurance. I must say, the health carriers are very suspicious when the students are submitting claims, and very often, the college student, with each and every claim, has to prove that they are the insured. I couldn’t believe […]
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 […]