Prior Authorization Denial, What to Do Next
That cold dread washing over you as you read the denial letter isn’t just disappointment—it’s a profound sense of injustice. When facing a prior authorization denial what to do next feels like an impossible question, a fight against a faceless corporate giant that holds your health in its hands. This moment of paralysis is exactly […]
Claim Denied? How to Write a Medical Claim Appeal Letter
That thick envelope from your insurance company sits on the table, and the words inside make your stomach sink: “CLAIM DENIED.” It’s a frustrating, infuriating, and often frightening moment. You followed the rules, you paid your premiums, yet a decision made by a faceless entity now threatens your financial stability. This feeling of powerlessness is […]
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 […]
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 […]
Coma Patient with a $300,000 CoPay?
I have to tell you this story. You have a traumatic brain injury and you wind up being in a coma for two months. Your commercial insurer informs your family that you will. They will definitely cover you, but after you leave the facility, you get a bill for over $300,000, which the provider claims […]
ER Medical Bill Not Medical Necessary?
I recently had a phone call involving a person who fell down two flights of stairs. They had 25 stitches in their head. The case involved a hospital in California, and after entering through the emergency room, the insurer felt it was not medically necessary for her to be at the hospital. The bills were […]
Why You Should Hire a Healthcare Advocate Today
Patients often find themselves overwhelmed by medical jargon, insurance complexities, and administrative hurdles. To effectively manage these challenges, many individuals choose to hire a healthcare advocate. These professionals serve as dedicated allies, guiding patients through the healthcare system to ensure they receive appropriate care and support. Understanding the Role of a Healthcare Advocate A healthcare […]
Cut Medical Costs with a Healthcare Billing Advocate
The U.S. healthcare system is a patchwork of disconnected billing systems, coding procedures, and third-party payment networks. Providers input codes, insurers process them with automated systems, and the patient ends up holding the bag for any mismatches or oversights. Hidden Causes Behind Sky-High Bills CPT and ICD coding errors that inflate charges Out-of-network providers billing […]
Food Poison $11,000 Medical Bill Down to $1,100
One of my clients had food poisoning. It was so bad that they were collapsing at home and wound up going to an emergency room. The ER did not have a contract with the insurance company, and my client was billed $11,000. I negotiated the bill down and they only needed to pay $1,100 10% […]
How Health Insurance Claim Advocates Win Appeals
Even the most legitimate claims—routine checkups, necessary surgeries, pre-authorized procedures—can be rejected. This isn’t just inconvenient; it can delay care, create financial pressure, and leave patients footing bills they thought were covered. The Hidden Triggers Behind Denied or Underpaid Claims Incorrect or missing CPT/ICD codes Lack of prior authorization despite provider verification “Experimental” treatment designations […]