Whatever you do, don’t ignore your medical bills. You have options. I make it my business to know your health insurance policy and advise what benefits you have. You have a go-to person to answer your questions, directly. The following are examples of people just like you…. who found themselves in a “pickle”.
Case Type #1: Coding Errors
A 38 year old woman diagnosed with breast cancer required a procedure that her health insurance company denied claiming it is not a covered benefit and therefore payment would not be authorized.
The insurance company denied the claim 3 times, the Dept of Health denied the claim 2 times before she sought an attorney. Her attorney referred her to me before settling the case.
In less than 90 days, I succeeded in getting her medical insurance company to pay the $10, 485.01 hospital bill in full with interest stating, ” You have no further financial responsibility for this claim.”
Anxious to buy their first home, the icing on the cake was, securing a letter from the collection agency… “deleting our entry from all credit bureaus”.
A 23 year old pregnant woman, went to the ER and consequently admitted to the hospital for further observation.
Her health insurance company denied the 5 days of charges ($2,757.00) incurred from her physician while she was in the hospital.
Ultimately I obtained authorization for her entire 8 day stay. The insurance company paid the hospital charges and the physician charges at the highest benefit according to the patient’s policy.
CASE Type #2: Out-Of-Network Referral Problems
A 13 year old girl was referred to me by a former client. This young girl was in need of a therapist specifically trained to counsel the family and the child with a very specific mental health diagnosis.
I succeeded in obtaining an “out-of-network” referral. This authorized her health insurance company to pay the provider, her therapist, at the highest benefit according to the family’s Certificate of Coverage.
I have secured repeated authorization for the past 5 years.
A 47 year old woman was scheduled for a double mastectomy. Her plastic surgeon was not a participating provider in her network. Prior to surgery, I obtained an authorization, an out-of-network referral from her health insurance company to pay the plastic surgeon’s charges as an in-network provider. As an added bonus, I succeeded in getting the insurance company to go retroactive. This reimbursed my client for the office visit, prior to surgery.
I prevailed in obtaining an out-of-network referral, for a surgeon who specialized in prosthetic implants, when a 49 year old man with a birth defect and was looking for an implant that would make him whole again.
The authorization considered the provider as participating and reimbursed my client at the highest benefit according to his policy.
Case Type #3: No Patient Responsibility
A 25 year old man, referred to me by a physician, was admitted to the hospital for an emergency hernia and incurred $16,992.18 in medical fees.
Working with his providers, the hospital, anesthesia, the surgeon, and radiology, I was successful in getting all the charges written off, in their entirety. My client has no patient responsibility; he owes nothing.
A 49 year old woman, referred to me by an insurance broker/colleague of mine, incurred $7,823.87 in medical charges for an outpatient procedure.
Not only was I successful in getting the charges written off, but I secured a refund of an initial payment she had made.