Claims and Billing Concerns

  • Are you overwhelmed by the number of statements you receive from various providers for your care?
  • Are you confused by the Explanation of Benefits (EOB) you get from your insurance company?
  • Do you know if your claim has been paid correctly by your insurer?
  • Is the amount of the bill (co-insurance or co-pay) you received higher than you expected?

If your answer is yes, then you may benefit from the services of an Independent Board-Certified Patient Advocate who has a background in medical coding, claims processing, and the audit of claims and hospital billing. Not all Patient Advocates have expertise in this area. At Patient Advocacy Solutions we understand how the insurance system works. If an issue arises from billing or claims processing errors, whether it be by the provider or insurer, we are here to help.

Denied Insurance Claims

Surprise Billing

  • Have you heard the term, “surprise billing” and do you believe you are being affected by it?
  • Are you being billed for out of network services that you believe should have been paid at the in-network rate?
  • Is the amount of the bill (co-insurance or co-pay) higher than you expected?
  • Did you receive a statement from a provider you never met?

Out of Network billing is when you receive a statement from a provider that is outside of your health plans network. These bills represent the difference between an out of network providers fee and the amount covered by your insurer. This issue can arise from emergency and

non-emergency care. Presently there are many states that have enacted legislation to protect consumers from the financial burden that can result from treatment provided by a out of network provider or facility.

To date, 33 states have enacted laws to protect consumers from balance billing. In 2020 Congress enacted the “No Surprises Act” to protect those who live in states that currently do not have this legislation. This federal law will go into effect in January of 2022. In spite of this legislation many providers will ignore the laws in some states that govern and protect consumers and attempt to collect monies from you that are not your responsibility. We at Patient Advocacy Solutions are here to challenge these claims so as to protect you from a financial burden that you did not anticipate.

Appeals of Denied Claims or Treatments

Did your doctor recommend or provide a service that was denied by your insurer?  

Many times, patients will find out that a treatment or procedure that their physician has recommended is denied or not covered by their plan. We are dedicated and equipped to investigate how this happens and make the appropriate appeals on your behalf. We are well versed in the appeal of denied claims and providing supporting evidence for services that have been recommended. We are able to communicate effectively with both your doctor or hospital and the insurer to overcome these obstacles. Most medical providers don’t have the personnel to deal with this arduous and time-consuming task but are more than willing to work with us as we advocate for you. 

Open Enrollment

Every year you get information from your employer, or Medicare giving you options to change your insurance coverage, thereby increasing or decreasing your out-of-pocket expenses and the amount of money deducted from your paycheck or billed to you directly. This is commonly  known as “Open Enrollment.” It typically occurs in the fall, where you get a big packet of information with options that confound and confuse the savviest of consumers. Your choice will affect you and your family for an entire year, so it’s important to choose carefully so as to avoid having to pay too much for coverage you may not use, or not paying enough to protect you financially over the coming year. Yes, you may be young and healthy, or rarely see your physician, but sadly accidents happen, or people are diagnosed with an illness or disease that requires prompt attention and treatment. If you align yourself with the right insurer, you could save hundreds or thousands of dollars, or find yourself underinsured and placing yourself at financial risk.  

Having a Board-Certified Patient Advocate with a background in the inner workings of the insurance industry is extremely important. Not all advocates posess the skills to assist you in analyzing your potential risk-based not only on your current state of health but also when faced with an emergency.

Medical and Health Insurance