Medical Billing/Appeals/Health Insurance
Personal Patient Advocates can do things like organize and review bills from multiple settings; ensure bills are correct; work to get insurance claims approved; or make sure primary and secondary insurances are being used to their fullest. With the complexity of our health care system and the multitude of insurance carriers, facilities, and providers, each maintaining their own set of policies, procedures, and clinical criteria, it is no wonder individuals become stressed and feel lost when trying to advocate for themselves or their family members. We, at Golden Isles Patient Advocate, assist individuals and caregivers by providing exceptional administrative support to handle the “business side” of medicine.
Administrative Support:
- Resolve issues with medical bills & claims.
- Research & assist in coordination of benefits (COB).
- Resolve Pharmacy Benefit confusion, including generics vs. brand name.
- Review all facility and provider bills against insurance EOB’s (Explanation of Benefits) to ensure appropriate billing and maximum claims reimbursement.
- Resolve insurance issues, ensuring application of individual’s FULL Benefits.
- Assist individuals and physicians with Pre-authorization Requests.
- Advise individuals and physicians on the appropriate use of out-of-network providers, and how to obtain approval BEFORE services are rendered.
- Counsel individuals and their caregivers on their member handbook, their benefits, including their Drug Formulary List.
- Advise individuals and physicians on the use of capitated providers, what it means, and the process to request an ‘out of cap’ approval.
- Seek to renegotiate provider & facility fees.
Appeals:
- Member & Provider Appeals
- Our Personal Patient Advocates provide guidance and assistance for Provider Appeals, Medical Director Review, Member Appeals, Member Grievance, and Medicare Administrative Law Judge (ALJ) cases. In many cases, we work directly with the physician, reviewing the medical information and providing guidance in drafting the necessary correspondence.
Insurance Plan Decisions:
- Assistance selecting the best insurance option for you based on your health issues, prescription drugs, favorite physicians, specialists and facilities.
- Review of drug plans annually.
- Helping you change plans if necessary.
- Assistance with the insurance application process.
- Search for rebates or tax advantages to choosing the right plan for you.
Disclaimer:
This information is not intended in any way meant to treat, prescribe, or diagnosis any medical or emotional condition. The information on this web site or in any distributed e-mail does not in any way eliminate, substitute, or replace the advice and treatments prescribed by a qualified health care provider of medical or psychiatric care. The information / content on this web site or in any distributed e-mail is not intended to diagnosis, treat, cure, or prevent any disease. You should not use this information to diagnosis or treat any health problems, disease, or illness without consulting your own physician or other qualified healthcare professionals. Please be advised that you must consult your physician immediately about any medical or psychological concerns or issues. Any links to this web site are provided solely as a customer service and convenience to you. We are not responsible for the content of any third party web site linked to or from this site. We are in no way responsible for reviewing, examining, or evaluating their offerings, content, or information. The use of any third party links, websites, and/or off-website pages is at your own risk. You agree that, to the fullest extent permitted by applicable law, that we will not be responsible or liable under any circumstances, for any interruption in business, system failures, malfunctions, or connectivity issues, computer viruses, corruption, destruction, or access disruptions in connection with the use of this site or while linking to or from any third party site, as well as any inaccuracies or omissions in content, or any events that are beyond our control. You agree and understand that it is your responsibility to consult with a qualified health care provider regarding any and all information or content found within this web site or any distributed e-mail prior to the use of said information and content.
