HUMAN HEALTH ADVOCATES EFFECTIVELY AND ECONOMICALLY PROVIDES THE FOLLOWING SERVICES TO ASSIST YOU WITH YOUR MEDICAL BILL AND HEALTH INSURANCE PROBLEMS:

1. MEDICAL BILL ORGANIZATION AND REVIEW. In order to ensure accuracy and avoid mistaken or unnecessary payments, we organize and review your medical bills.

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A) We deal with invoices from hospitals (including emergency room treatment, inpatient care, rehabilitative treatment and other hospital services), diagnostic facilities, laboratories, physicians and other providers. We also review the “Estimate of Benefits” that you receive from your insurance company. After careful analysis and reconciliation of your statements, we may suggest, and. with your approval, initiate corrective action on your part. In such cases, we may interact with providers and insurers to ensure that you do not pay more than necessary.


2. ONGOING BILL MANAGEMENT. In many cases, our clients find that this service is excellent for long – term use; saving time and money, while reducing the stress of dealing with their bills and insurance. This can help you from being overwhelmed with bills and insurance statements.

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A) This service is ideal for many types of patients. For example-if you have a serious illness, requiring long-term care, possibly with long-term hospitalization and rehabilitation. We can help.. In such cases, it may be quite difficult to determine which bills to pay, which need clarification, and which should be contested. When we handle these matters for you it will alleviate significant stress and anxiety and help you avoid paying incorrect bills. This is also true for our clients that that would prefer not to spend the time filtering through bills and insurance statements to make these same determinations; risking financial errors as well as unnecessary stress.


3. APPEALS and RECONSIDERATIONS of DENIAL of COVERAGE – PPO/HMO/LTC.
When coverage for a claim is denied by your health insurance company, we take definitive steps to address the problem, including preparing and managing both re-considerations and appeals.

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A) We investigate to ensure that the claim has been properly submitted to the insurance company by the medical billing personnel. In most cases, you have the right to have a denial of coverage reconsidered by your health insurer, or to engage in a more formal appeal. We compile necessary medical, billing, and insurance records, and correspondence. When appropriate, we contact your physician. After review of all materials, and in certain cases, consultation with experts in various areas, we prepare a reconsideration and/or appeal on your behalf.

B) Appeals and Reconsiderations of Denial of Coverage (Long-Term Care Policy). We also prepare appeals from denials of benefits by long-term care insurance companies. When the insurer denies initial benefits (such as an aide or financial contribution toward assisted living), or discontinues such benefits, we interact with your physicians and caregivers in order to obtain the necessary medical records and plan of care and initiate and manage an appeal on your behalf.


4. HOSPITAL and PROVIDER NEGOTIATION of PAYMENT REDUCTIONS.

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A) When insurance coverage is unavailable, we communicate with providers and their billing companies on your behalf; seeking to negotiate lower charges for you. This can be critical, as the high costs of hospital treatment and other medical services can literally lead to financial ruin At times, reductions in fees can be obtained even when one has insurance coverage. Advocates are nearly always more successful with obtaining reductions and preferential payment plans than individual patients on their own.


5. UNINSURED PATIENT ASSISTANCE.

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A) If you are uninsured, we can help by negotiating discounted rates for nearly all treatments, hospital services, and testing. Substantial cost reductions are available if payment arrangements are made before treatment or hospitalization. We also seek to negotiate reductions in charges after treatment. We may also be able assist you in locating plans to obtain your prescriptions at a reduced cost as well as point you toward other available resources.


6. KNOW YOUR HEALTH INSURANCE and PATIENT’S RIGHTS.

Many people think that because they have insurance their medical expenses “are covered.” This is not always the case. A better understanding of your health insurance policy and Patient’s Rights will give you more control of medical costs that you incur.

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A) This one-on-one service is an invaluable tool designed to help you better understand how your health insurance coverage and benefits work. The tutorial can be conducted in our Boca Raton office or by telephone; whichever is more convenient for you. Together, we will review various aspects of your insurance policy. This will improve your understanding you’re your health insurance coverage-resulting in a savings of time, money, and frustration. This valuable initial service is the single best way to educate and protect yourself in the confusing and expensive world of medical services and the health insurance industry.

B) In-Network vs. Out-of-Network Services. We explain the great difference in cost to you depending upon your usage of in-network vs. out-of-network, physicians, labs, diagnostic facilities, urgent care facilities, pharmacies, and hospitals. You will be shown how to make the most cost-efficient choices regarding medical provider options—resulting in avoiding drastically higher medical bills. Using an out-of-network provider can cost you additional hundreds or even thousands of dollars—money that you did not need to spend. Knowledge is power – and we help pass on a better understanding of this very important aspect of your health insurance coverage.

C) Pre-Authorization. We address the requirement of “pre-authorization” contained in your insurance policy. Each insurance company requires preauthorization to be obtained prior to undergoing different medical procedures. Although your physician’s office and testing/surgical facility usually work together effectively and obtain the preauthorization, there are times when there is a breakdown in communication. We will address what you can do to avoid hefty charges that could occur in such circumstances. Failure to follow your insurance company’s rules may result in greater expense or denial of coverage. Our tutorial can help avoid that as well as reduce the inconvenience of postponing or rescheduling procedures.

D) Drug Formulary. Understanding your insurance company’s drug formulary may help avoid delays in or denials of access to your prescriptions. Many people do not even know what a drug formulary is, let alone the fact that their prescriptions are governed by its contents. Sometimes, insurers completely deny coverage for certain drugs prescribed by your doctor. Patients can be without their medication for weeks – getting the runaround from their insurance companies. Prescription costs can vary dramatically. Understanding the operation of your insurance policy’s drug formulary and working with your doctors can reduce delays obtaining the medicines you need, as well as save you considerable amounts of money.

ADDITIONAL SERVICES

A. Medical and Diagnostic Procedure Cost Saving Information

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In certain situations, it may be financially advantageous for both insured and uninsured persons to “self-pay” for a procedure. In such cases, we will gather costs from various providers which will provide you with additional information with which to me a more informed decision.

B. Medical Record Retrieval

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We prepare or assist you in preparing HIPAA-compliant requests for specific medical and medical billing records from your providers and insurers necessary for use in connection with our work on your behalf.

C. Preventative Services Information

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This service informs you about the existence of important preventative medical services mandated by the Affordable Care Act that might be available at no cost to you. All such services must be obtained from medical providers within your insurance company’s network. You will need to discuss with your doctor which treatments you would be eligible for and whether they would be appropriate for you.

 

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