August 03, 2020

Experienced Health Benefits Advocacy

Sometimes getting a medical claim paid correctly can be a real battle. It starts when a charge that should be covered is denied. You call customer service, and they tell you that it will be reprocessed. Then, in a few days, another denial arrives with a brand new denial code. You call again. It's denied again. And it may stay that way if it's stuck now in this health insurance claims adjudication netherworld where nothing is paid easily, if at all. 
Recently a clinic manager told me; "Resolving wrongly denied medical claims used to be easy; A biller working in our office would stamp “APPEAL” in big red letters on a photocopy of the claim, and mail it back to the insurance company. These days, you’d be wise to put the cost of that postage in the bank, and throw away both the APPEAL stamp and its red ink stamp pad because it won’t even make it past the insurance company’s initial computer screening. They’ll toss it into the trash and you’ll never hear anything back from them. Today, you need to get your 'A-game' on. Otherwise, you won’t see a penny."
Getting your A-game on is why was created. Available here is what you need to get medical claims paid correctly. The tools, case studies, helpline and all other resources are specifically designed to enable you to overcome all the obstacles that a health insurer commonly puts up. If you understand what's really happening through the various stages of the life of a claim, you can usually avoid the pitfalls that often result in wrongly denied or rejected medical claims. And once you know that, you can then determine if, when and where the system went sideways and proceed accordingly.  Be your own advocate!
If you find that you still have claims that you can't get paid right, and you don't have the time, inclination, bank acount or stomach for dealing with the process anymore, we'll help you without blowing your already-stretched budget. Our goal is to make the health insurance company pay.

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