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September 23, 2014

Experienced, Effective 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 it's their "bad," and 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 now it will normally stay that way because it's caught up in a vicious cycle - a claims netherworld where nothing is paid easily if at all. This is underscored every year by the AMA's scorecard of claims payment accuracy in their Heal the Claim initiative. It generally shows somewhere around a 20% error rate for the big seven insurers which would never be tolerated in any other industry that I know of.
 
Recently a clinic manager told me, "Resolving wrongly denied medical claims used to be a simple process. 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 MedicalClaimsHelp 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. Once you know that, you can then determine where the system went sideways and proceed accordingly to get it done right. Be your own advocate!
 
If you have claims that you still can't get paid right - and you don't have the time, inclination or stomach for dealing with the greedy insurance companies process, it would be a privilege to act as your advocate. Our goal is to provide expert medical claims help to you without blowing your already-stretched (by the insurance company) budget. If we help you, donate, whatever you can afford. Getting the insurance company to pay what they owe without too much of a fuss is the main thing. They use every single trick in the book, but they know when they're beat, or it's no longer worth their time and other resources. Ahem.

It's a fact that 64% of all appeals win! But the saddest news is that less than 10% of all providers or patients actually appeal bad decisions made by the insurer. They don’t fight for their right to be compensated for services rendered in good faith and in times of intense anxiety for all concerned. However, if a health insurance company screws you – fight back. An insurer claims that you can’t do or receive X, Y and Z procedures all on the same date even though you added modifiers correctly – fight back! Someone denies your care as experimental or not medically necessary, don’t accept their word as gospel. Hold on to your wallet and fight back!

We'll do our best to help you in every way possible way because I and everyone that I work with is a past or present employee of a major health insurer with a proven personal track record of looking after the interests of members and providers. We know how claims should be paid. Let's get started today.
 
Pat Shea, F.H.I.A.S.
 
 Director, MedicalClaimsHelp.org
                                                     
Claims Assistance Professional   

This filmmaker's view of the health insurrance business may be one of those instances in which life really does imitate art.

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