Are You Really Covered by Your Medicare Advantage Plan?
When people decide that they want to take a Medicare Advantage plan, they do not realize that so many hospitals are no longer accepting the Advantage plans. I recently had a case where the person was admitted to the hospital. The hospital was participating and accepted a Medicare Advantage plan, but within two days after […]
Denied Medical Claim While on Health Marketplace
A case recently involved my client being in a hospital for emergency brain tumor surgery. They had a policy through the Affordable Care Act in New York State, and I could not believe that they were denying the claims. It took about 10 months to cover to turn the case over, but finally, the bill […]
Medical Bill Reduced from $150,000 to $5,000 With Travel Insurance
You know, much too often people purchase travel insurance and they come here, the United States. Every case that has come to me when the visitor is in the United States, they always wind up in emergency room and they’re hospitalized for a pre-existing condition, which is always an exclusion on the policy. I’ve recently […]
Are New Employees Covered by Self Insurance Coverage?
I hope you’re having a fabulous day today. It is so difficult to fight for coverages when your company is so large and they have a self-funded, self-insured or risk plan. Many employers do not want to pay large claims for recent hired employees unless they are so well liked that the employer is willing […]
Patient Advocate vs Medical Billing Advocate: Read This First
Navigating the murky waters of the healthcare system can feel like you’re drowning. The debate over a patient advocate vs medical billing advocate is more than semantics; it’s about choosing the right champion for your specific battle. You’re facing a mountain of incomprehensible paperwork, cryptic denial letters from your insurer, and bills that read like […]
Out of Network Providers Can Still be Paid by Insurance
I recently had a case where surgery was required. None of the in-network providers were able to perform the services. It took four months, but we were finally able to get a single case agreement with an out of network provider, and the insurance company finally agreed to pay the in-network fees. If you ever […]
Misinformed About What Medical Insurance Covers
One of my recent clients was informed the provider was in network. They went for the surgery and later found out that the provider was really out of network and they were never covered. The fact that they were misinformed, I was able to get the bill from $29,000 down to zero due to their […]
Why Every Texan Needs a Medical Advocate Texas Today
In the vast and often complex healthcare landscape of Texas, patients frequently encounter challenges that can be overwhelming. From deciphering intricate medical bills to coordinating care among multiple providers, the journey can be daunting. Enter the role of a medical advocate in Texas—a professional dedicated to guiding patients through these complexities, ensuring they receive the […]
$85,000 Pre-authorized Medical Bill Denied
Good afternoon, my friends, one of my clients had a pre-authorization for radiation due to rectal cancer. The bills were over $85,000, and even though she had pre-authorization, the insurance company did not want to pay it. Since the hospital at the time was out of network. The fact that there was pre-authorization, even though […]
Hospital Billing Advocate Secrets Doctors Don’t Tell You
A hospital billing advocate is a professional who assists patients in reviewing, understanding, and negotiating medical bills to ensure accuracy and fairness. By leveraging their expertise, these advocates help patients navigate the complexities of hospital billing, potentially saving them significant amounts of money and reducing stress. What Is a Hospital Billing Advocate? A hospital billing […]