By Martine G. Brousse (still not AI!) "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   April 23, 2024   The past few years have seen an increase in plans using a "Tier" system, both in their Pharmacy Directories and for medical services. How does this work, and why should you care? Is it all about money ? Let's explore! A. What is the "Tier" system? For medical services, it is designed with these goals in mind: insurance members: it is a system of financial incentives to use top-performing providers (for quality of care and bet ..read more

By Martine G. Brousse (not AI!) "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   April 10, 2024   Units are often used in Billing, so that insurance companies understand better what specific medical service was rendered to a patient and how long it took, or how much medication was prescribed. Units are descriptive codes which can get a claim denied, so let’s explore their small but mighty influence.   A.   Two kinds of Units : Time and Dose   1.     Many procedure codes used to bill an insurance already include ..read more

  By Martine G. Brousse (nope, not AI) "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   March 25, 2024 While we all understand that using an Out Of Network is not beneficial to our wallet, and in some cases not even covered by our insurance plan, there are 6 good reasons why it may be necessary to do so. Should this happen, there are remedies to force the insurance to cover such services at the Higher In Network and therefore save you $. A. Quick reminder: In vs Out In Network is the highest level of pay from your insurance - and therefore preferred. It ..read more

  By Martine G. Brousse (not AI!) "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   March 16, 2024    You get EOBs from your insurance company every time a claim sent by a medical provider is processed. It is one of the most important document you can received from your insurance. It is imperative that every patient be familiar with what an EOB is, and what it means, as their financial circumstances will be affected by this document. A. What is An "EOB"? "EOB" means "Explanation Of Benefits". It is the description showing what medical service wa ..read more

By Martine G. Brousse  (not AI!) "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro March 4, 2024 Do you know the status of every account you have with every medical provider and facility that you consulted or that treated you? Are you sure they can be trusted to refund you what you might have overpaid? As a previous billing manager, I can attest to an ugly but all too common practice (not mine though!) : credits owed to patients are not always issued. Sometimes, they are not even identified unless you ask. A refund is owed to you if: ·    &n ..read more

By Martine G. Brousse (not AI!) "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   February 5, 2024   Watch the video: https://youtu.be/O7UOF-1pZbE    What is a “patient Advocate”, what do they do and how can they help you? Let me explain!   A.   HOUSEKEEPING FIRST 1.     The dictionary defines an advocate as a defender, supporter, promoter, champion of a cause or person. It is not wrong. Advocates are “helpers” 2.     An advocate meets your needs (financial, legal, clinical), watches o ..read more

By Martine G. Brousse "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   January 22, 2024   Watch the video:   “Medical Necessity” affects your medical care at every level as well as your wallet. Are you aware of what it means exactly?   It is based on a number of points of view. To keep it simple:     A.   MEDICAL POINT OF VIEW   “Medical Necessity” is what your Dr or medical practitioner deem to be the necessary, appropriate, indicated, responsible steps needed now to establish a diagnosis and prescribe the safest, most ..read more

By Martine G. Brousse "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   January 5, 2024   Watch the video:   There are a number of reasons why your insurance plan would reject payment of a lab test. The two most common were explored here: https://www.advimedpro.com/post/denied-lab-tests-fix-it-part-1 But LDT tests (Lab-developed tests) are sometimes harder to get paid. Let’s see why.   A.    WHAT IS A LDT TEST?   ·      It means “Laboratory developed test” ·      These are tes ..read more

By Martine G. Brousse "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   January 3, 2024   Watch the video: https://youtu.be/SW3odhgNLno   There are a number of reasons why your insurance plan would reject payment of a lab test. Today we will see how to fix the most common reason: THINGS DON’T MATCH THAT SHOULD!   A.    Coding errors   1.     Coding and Billing protocols are simple: any medical procedure/service/lab/test/supply/item/intervention/care/Rx/consultation/device MUST have a specific, documented ..read more

By Martine G. Brousse "The Medical Bill Whisperer" Patient Advocate, Certified Mediator AdvimedPro   January 3, 2024   Watch the video: https://youtu.be/SW3odhgNLno   There are 2 kinds of lab tests. How do their differences affect your insurance coverage and your bottom line? Let’s explore some more:   A.    Terminology clarification   The term “lab” in healthcare can mean 2 things: 1.     The actual laboratory, structure, place, facility that handles and processes your samples and issue a report on its findings 2.   &n ..read more