HUMAN HEALTH ADVOCATES EFFECTIVELY AND ECONOMICALLY PROVIDES THE FOLLOWING SERVICES TO ASSIST YOU WITH YOUR MEDICAL BILL AND HEALTH INSURANCE PROBLEMS
HEALTH INSURANCE RECONSIDERATIONS & APPEALS OF DENIALS OF COVERAGE – PPO/HMO/EPO
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 insurance reconsiderations and appeals. 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 correspondence, clinical, medical billing, and insurance records. When appropriate, we contact your physician(s), hospital, and other providers. After a thorough review of all materials, we may seek a reconsideration and/or prepare an insurance appeal on your behalf.
HOSPITAL & PROVIDER PAYMENT REDUCTION NEGOTIATIONS
When insurance coverage is denied or otherwise 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 in obtaining reductions and preferential payment plans than individual patients on their own.
UNINSURED/UNDERINSURED COST REDUCTION NEGOTIATIONS
If you are uninsured, or your coverage doesn’t extend to the types of expenses incurred, we can help by negotiating reductions in invoice amounts; as well as discounted rates for nearly all treatments, hospital services, testing, and prescriptions. Substantial cost reductions are available if payment arrangements are made before treatment or hospitalization. We also seek to negotiate reductions in charges after treatment.
LONG-TERM CARE POLICY APPEALS
We also prepare appeals from denials of benefits by long-term care insurance companies. The insurer sometimes denies initial benefits (commencement of policy) or discontinues benefits which are often spent for care by nurses, aides, therapists or financial contribution toward assisted living. Our protocol includes an available in-home visit (with a nurse, home health agency representative, advocate, and the patient’s representative as appropriate), meeting with health care staff, interact with your physicians, and others, in order to obtain the necessary medical records and plan of care to prepare and manage an appeal on your behalf.
PROBATE MEDICAL CLAIM REDUCTION
Many Estates have claims made against them for medical debts of the decedent. While attorneys and Personal Representatives diligently manage the probate process, our services can result in significant savings to the Estate. Thus, there may be more assets available for distribution to the beneficiaries. We work with the Personal Representative and attorneys, review medical invoices for accuracy, compile medical records, consult with our experts, and ascertain whether health insurance benefits could be available. If so, we might interact with the provider to submit corrected claims, additional clinical support, or even commence a provider’s appeal. As appropriate, we submit claims, seek reconsiderations, and prepare appeals.
Assuming no insurance coverage is available, we utilize our proven expertise to negotiate reductions in the amount of the claims. Medical providers generally seek to collect higher rates from Estates than from an insured individual (private insurance, Medicare, or otherwise). We believe it to be unfair to deprive the family of a loved one to unnecessarily pay excessive amounts rather than distribute the savings for college educations, home improvements, retirement funds, and other much better uses. Consult with us and allow our team to assist the Estate in reducing claimed medical debt. The payments for medical debt by the Estate are likely to be reduced; often substantially.
MEDICAL BILL ORGANIZATION & ANALYSIS
In order to ensure accuracy and avoid mistaken or unnecessary payments, we organize and review your medical bills. 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 “Explanation 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. We might also initiate review by your insurer, including preparation of an appeal for charges wrongfully denied.
UNDERSTANDING YOUR HEALTH INSURANCE & PATIENT’S RIGHTS (CUSTOMIZED TUTORIAL)
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 over medical costs that you incur.
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, by telephone or by Skype; whichever is more convenient for you. Together, we will review various aspects of your insurance policy. This will increase knowledge of how your health insurance coverage operates- resulting in a savings of time, money, and frustration. This valuable service is an excellent way to educate and protect yourself in the confusing and expensive world of medical services and the health insurance industry.
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.
Pre-Authorization. We address the requirement of “pre-authorization” contained in your insurance policy. Each insurance company requires pre-authorization 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 pre-authorization, 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.
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.
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.
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.