In this insightful interview, Edison Guzman speaks with Adria Gross, founder of Medwise Insurance Advocacy, about the challenges and solutions surrounding denied medical claims. Adria shares her expertise as a former insurance claims processor who now helps individuals fight back against unjust claim denials.
The discussion begins with common reasons for claim denials, including procedural errors, preexisting conditions, out-of-network providers, and coding mistakes. Adria emphasizes the importance of carefully reviewing Explanation of Benefits (EOB) documents and medical bills for inaccuracies, such as duplicate charges or incorrectly coded procedures. She provides practical advice on identifying and addressing these issues before escalating them.
Adria highlights her high success rate—over 90%—in overturning denied claims, thanks to her extensive knowledge of insurance policies and appeals processes. She stresses the importance of persistence, advising individuals to appeal claims multiple times before seeking professional help or escalating to state authorities. Adria also underscores the value of her book, which guides individuals through self-advocacy in the appeals process, and her services for more complex cases involving large sums.
This engaging and informative interview equips viewers with actionable insights to tackle denied medical claims and empowers them to advocate for their financial well-being.
