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“A patient advocate, I use knowledge and experience to help patients manage medical bills, reduce costs and save $. ”
I am a healthcare industry expert with over two decades of medical billing management experience and vast experience with the intricacies of navigating all types of payment claim issues. It was in direct response to what I saw as a lack of resources for patients to effectively anticipate and manage medical expenses that I created ADVIMED, my Patient Advocacy company.
Now working on the side of patients, I assist them with resolving the many issues they may face with medical providers and insurers. My services include: patient advocacy, bill auditing, fee negotiations, medical account management, research & education and mediation. I also lead family conferences to establish a course of action and ensure all parties are on board.
Applying my insider knowledge, familiarity with all aspects of the healthcare industry, creativity and skills as a certified mediator, I present options, advise on strategy and find solutions. I foster collaboration and encourage dialogue to bring about successful resolutions. I bring patients the assurance that a bill is truly owed or a claim correctly processed, while safeguarding their rights.
I have written a guide to free resources, assistance, and support for cancer patients. In it, I present practical advice, cost-saving tips, and valuable information to help them locate resources in many forms.
I lecture at local Cancer Support Community Centers on various ways to save money and effectively resolve financial, insurance or billing issues.
Read my weekly blog: " Patient Advocacy: Healthcare on your Side" for practical solutions, relevant information, useful news and insider tips on getting the best out of the healthcare industry. I strongly believe in educating and encouraging patients to become more active, and better informed participants in their care.
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Whether it is covered is irrelevant. A covered benefit does not mean it is payable for everyone, under
Whether it is covered is irrelevant. A covered benefit does not mean it is payable for everyone, under any circumstance.The important question is was any authorization requested?
A surgery, especially if elective, usually requires a pre-authorization from your insurance.
That is the surgeon's job to obtain. Appealing the insurance company is within your rights, however your chances of success depend on your policy and wording on your insurance Explanation of Benefit.
If your policy states an authorization was required but not obtained, you are likely out of luck. Again, depending on the surgeon's "mistake", you may be able to appeal and ask for a retro-authorization.
If the denial is: "elective" or "experimental" procedure, and an authorization was not required, then you have great chances of obtaining a reversal. What you need is to establish the "medical necessity' for the procedure, including previous less radical but unsuccessful treatments, list medications that did not work or that provoke side effects, physical therapy or any other modalities which were not helpful. Any MRI report or medical report from a specialist, determining that the only and last treatment option was this surgery, should be included. Your surgeon should provide you with this documentation, and file an appeal as well.
If your appeal is denied, and depending on the state you reside in, you may be able to file a complaint or ask for an independent review through the insurance commissioner's office. Check your policy too for steps to file a second degree appeal.
If all fails, you should negotiate lower fees, especially if neither the surgeon nor the facility checked on the requirement to get an authorization.
I general yes. Charges for C/sections involve the use of the OR, the services of an anesthesiologist
I general yes. Charges for C/sections involve the use of the OR, the services of an anesthesiologist and of a surgeon, as well as a longer hospital stay. All these charges (and including post op pain management, medications, supplies and other services a regular delivery does not require) are expensive and may cost (tens of) thousands of dollars more than a regular delivery.
Your cost will depend on your insurance and your policy.
You will be responsible for a yearly deductible, yearly out-of-pocket costs (after you pay the deductible, your insurance pays a certain % of charges, leaving you with a balance) . In some cases you may be liable for a cop-pay every time you visit your doctor.
Depending on those 3 figures, your liability in case of a C/Section may be higher. If you have a low deductible and/or out of pocket, you should not see a difference. Only the insurance payments to the various providers will be higher.
If your liability is high, consider you will owe the full sum of these figures in case of a C/section. In case of a regular delivery, you might not.
Also, your doctor will need to get an authorization to schedule a C/section, explaining the medical necessity (twins, serious underlining condition etc). If not, unless the C/section is due to an emergency, your insurance may reduce their payments, or even deny it as "not medically necessary".
The best option is to contact your insurance customer service rep and ask about your yearly liability. Your physician should provide you with an estimate of costs.
If you are a cash patient, now is the time to shop around and negotiate. Do not agree to any service without a written estimate and make sure you ask several providers and facilities for their best offer.
The first thing I would recommend is to make a payment, however small, to show good faith and prevent
The first thing I would recommend is to make a payment, however small, to show good faith and prevent collection action.
Send your payment with a note you are working on a solution and asking for a billing manager to contact you regarding filing for "charity" through the hospital charity fund. While you wait for a response, your account should be marked as "pending" and not be sent to collection.
That is a tricky question! Technically, the subscriber or policy holder is financially responsible for
That is a tricky question!
Technically, the subscriber or policy holder is financially responsible for bills incurred by a dependent on the policy. But if the patient and NOT the policy holder signed the "promise of payment' form at the office or facility, then waters are murkier.
Because the Explanation of Benefit from the insurance show the name of the subscriber and indicate the "amount you owe" on the same page, this debt may be legally binding even if the subscriber did not sign the any document.
A good question is: does the medical provider have the social security of the subscriber, or can they obtain it through the insurance? If yes, then consider that your credit may be jeopardized in the case of non-payment.
If you can enroll back at any time into a MediGap or secondary plan should the worst happen, then saving
If you can enroll back at any time into a MediGap or secondary plan should the worst happen, then saving that premium money might be a good idea.
Do you have a HSA plan you could contribute to?
If you choose to continue your enrollment, remember premiums may be deductible on your tax return as a medical expense.