Medical Insurance Advocacy

Patient Medical Insurance Advocacy

If you had a serious illness or are challenged by one now, and your health insurance company has refused to pay for your medical care or drugs, you have four choices:
  1. Don’t get the treatment;
  2. Get the treatment and pay for the bill yourself;
  3. Do nothing and go to collections; or
  4. Call me
I have seen this from the inside of large organizations and from the perspective of patients. The stakes are real and the unnecessary pressure of this is not what you need now. Imagine having this weight lifted from your shoulders?
Health insurance is serious business. The only way insurance companies make money, is if the take in more than they spend on coverage. It is important that you get the coverage you have paid for. We have the background of working inside health systems to help you navigate through – now.
There are several thing you can do on your own to get the health insurance company to pay. The effectiveness of which is often questionable, and they cost you time. They cost you money. They cost you the energy and focus you need to deal with your health,or that of your loved one, here and now. Insurance policies are confusing and the medical bills are daunting. Don’t let the bills and the paperwork overwhelm you when you need to focus on your health,or that of the one you are committed to caring for.

We can help.

If you want to tackle this on your own, here are five things you - the patient - can attempt to do to get the insurance company to pay for medical bills:

Contact your Plan Sponsor/Administrator – which is usually someone in your employer’s office, usually in human resources.

  1. Ask to contact the insurance agent who provides your employer the company health insurance plans.
  2. Contact directly the claims administrator inside the insurance company.
  3. Contact directly the legal service processor inside the insurance company.
  4. Contact the State – Division or Department of Insurance – Helpline.

 However, if and when that fails, as we have seen happen so often, you should closely examine why the denial has occurred; or retain a patient advocacy attorney in our firm.

Here are some typical reasons for denial of health insurance coverage are:

  • the benefits are expressly excluded from the policy;
  • the service or procedure is denied as not medically necessary (i.e. cosmetic surgery versus severely drooping eyelids);
  • the medical provider was out of network;
  • the medical service or procedure is experimental;
  • the doctor failed to obtain preauthorization.

If you believe that your need for a medical service, procedure or drug is:

  1. Not specifically excluded from the policy; or
  2. That it was medically necessary; or
  3. That you were covered under the policy during that period;

then you have a fighting chance to have the costs covered and paid for by the insurance company. That is when you should contact our office.  

We will efficiently work with your existing physician to build a case for your treatments to be reimbursed.  If you do not have a physician on your side,  advocating for you the way you want – the way you need; we have physicians may be of assistance to you to work with you as a team.

We know you are hurting now. Stressed and challenged. Maybe scared for yourself, or your loved one. You are not alone. Reach out to us. We have been there for many people in the same place you are now. We are here now. We will be there for you on this journey.

FOR PERSONALIZED ATTENTION OF LEGAL COUNSEL

Free Initial Review and Consultation

For a confidential consultation call/text at (954)445-5503 or email me at BAM@HealthcareAttorney.Net
Ben Assad Mirza, Esq., CHC, CPA, JD, LLM, MPHA
Important Note: If you need legal advice that is more state law specific than what is required by Federal Statutes, please advise us so we may connect you with the right legal counsel licensed in the state you are inquiring about. 

FOR PERSONALIZED ATTENTION OF LEGAL COUNSEL

Free Initial Review and Consultation

For a confidential consultation call/text at (954)445-5503 or email me at BAM@HealthcareAttorney.Net
Ben Assad Mirza, Esq., CHC, CPA, JD, LLM, MPHA
Important Note: If you need legal advice that is more state law specific than what is required by Federal Statutes, please advise us so we may connect you with the right legal counsel licensed in the state you are inquiring about. 

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