Human Health Advocates

Preauthorization requirements, when health plans (health insurance companies) require patients to obtain approval before receiving treatments, are a predatory practice put in place by insurance companies to increase profit and limit accessibility to care covered by insurance. Studies show these requirements “wreak havoc” on patient outcomes, physician burnout and productivity. Read more about it on our website:

Human Health Advocates | Your Partner in Medical Advocacy Human Health Advocates, founded in 2015, has continuously and successfully helped patients lower medical debt and overcome insurance denials.

Human Health Advocates has been proudly and successfully assisting patients and their family medical debt for more than nine years. Based in Boca Raton, Florida, we practice nationally.

Human Health Advocates, LLC Human Health Advocates, LLC. provides services to assist you with Medical Bills and Health Insurance issues.

PRE-AUTHORIZATION 202—ROADBLOCK TO CARE? Part 1

By Kenneth Klein, BCPA and Morgan Kelley-Human Health Advocates

Healthcare providers must often obtain approval, referred to as pre-authorization or prior authorization, from the insurance company before certain treatments, procedures, or medications will be covered. Health insurance companies say that this approval is necessary to ensure that the requested service is medically necessary and appropriate based on the patient's condition. Typically, inpatient hospitalization, most surgical procedures (inpatient and outpatient), imaging (PET Scans, MRI’s, CT Scans), and many medications require pre-authorization. Ostensibly, prior authorizations act as a check to prevent unnecessary or inappropriate healthcare services, helping to manage costs for both patients and insurance companies.

However, obtaining pre-authorization can be a major barrier to accessing healthcare. The process can be time consuming and cumbersome, requiring healthcare providers to submit detailed documentation and justification for the requested service. Delays in obtaining pre-authorization can lead to delayed or denied care, impact patient outcomes, and cause frustration for both patients and healthcare providers. Additionally, the criteria used by insurance companies to approve or deny pre-authorization do not always align with the best interests of patients, thereby creating further challenges in navigating the healthcare system.

Everyone should be familiar with their insurance policy’s requirements concerning pre-authorization. Insurers have different procedures and medications that are subject to this possible roadblock. Human Health Advocates recommends that everyone establish an account with their health insurer’s member portal. Typically, those services, medications, and medical equipment that require pre-authorization are listed online and accessible through your portal. This is also a good tool for monitoring claims and checking benefits. It is important to verify that, when required, pre-authorization is obtained before undergoing a treatment or purchasing medication or medical equipment. One should insist on seeing a copy of the pre-authorization, if possible.

Insurance companies and many providers have contractually shifted the burden of obtaining a pre-authorization to the patient. This is counterpoint to the reality of obtaining pre-authorization. It is typically necessary to establish medical necessity in the request for pre-authorization. The CPT codes for procedures or the codes for drugs are in the possession of our doctors and, without diagnosis and procedure codes, the request will be denied. Patients are typically not in possession of the necessary information. However, if your provider’s office fails to correctly submit these requests in a timely manner, the request will be denied. Even the smallest error (incorrect code, wrong number of days in hospital, or which type of medications your doctor requests) in the pre-authorization might result in denial or even non-payment. Best practices suggest that one verify that the pre-authorization has been submitted and approved rather than counting on administrative personnel’s assurances.

Medicare Advantage plans frequently require prior authorizations for services or prescription medication. “More than 35 million prior authorization requests were submitted to Medicare Advantage insurers” on behalf of patients in 2021 (Biniek & Sroczynski, 2023). Physicians say that prior authorizations adversely affect patients by acting as a roadblock to receiving care in a timely manner, Sometimes, this results in patients abandoning treatment altogether, and has even led to a life-threatening event (American Medical Association & American Medical Association, 2023). However, Medicare Advantage plans are falling out of favor with many providers, due to excessive denials and slow/low payments. More to follow in Part 2

Sources

American Medical Association & American Medical Association. (2023, March 29). 1 in 3 doctors has seen prior auth lead to serious adverse event. American Medical Association. https://www.ama-assn.org/practice-management/prior-authorization/1-3-doctors-has-seen-prior-auth-lead-serious-adverse-event

Biniek, J. F., & Sroczynski, N. (2023, February 3). Over 35 million prior authorization requests were submitted to Medicare Advantage Plans in 2021 | KFF. KFF. https://www.kff.org/medicare/issue-brief/over-35-million-prior-authorization-requests-were-submitted-to-medicare-advantage-plans-in-2021/ #:~:text=Just%20over%202%20million%20prior,or%20in%20part%20in%202021.
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Human Health Advocates has been proudly and successfully assisting patients and their family medical debt for more than nine years. Based in Boca Raton, Florida, we practice nationally.

https://humanhealthadvocates.com

Human Health Advocates Human Health Advocates, LLC. provides services to assist with your medical billing & health insurance

As we contemplate 2024 arriving, Human Health Advocates would like to thank all of the billing and revenue cycle personnel that have worked cooperatively with us to resolve medical debt for patients.

We are grateful and wish you each Happy Holidays and a Healthy New Year!

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HUMAN HEALTH ADVOCATES
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Get Help with Medical Bills and Insurance Claims Our team at Human Health Advocates helps people resolve extremely high medical bills and denied insurance claims.

HUMAN HEALTH ADVOCATES wishes everyone Happy Holidays and a healthy and prosperous New Year. We have been helping patients and their families reduce or eliminate medical debt since 2015. REMEMBER, if you have medical bills that are overwhelming you, or you just need a clearer understanding of your situation, get in touch! we can help.
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DON'T STALL, JUST CALL!

HUMAN HEALTH ADVOCATES
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Get Help with Medical Bills and Insurance Claims Our team at Human Health Advocates helps people resolve extremely high medical bills and denied insurance claims.

The real and lasting damage often done regarding medical debt occurs when it is reported, subsequently paid off, yet remains on the patient’s credit report for a full seven (7) years. That is no more. Paid medical debt is eligible for immediate removal from the credit report. Accordingly, one should check their credit report for old medical debt that may have been resolved and seek to have it removed from their report. Protect your credit score. Obtain and review your free credit report this year. It may be time well spent.

You might have debt reported of which you are unaware. You might have medical debt that was paid off that remains on your credit report to this day. Don’t rely upon the credit reporting agencies to do everything correctly. They could easily overlook a reported medical debt that is entitled to be removed. Take a few moments and obtain and review your free credit. It could improve your credit score measurably.

To obtain your free reports, go to: www.annualcreditreport.com .

For a more comprehensive explanation, see the Consumer Finance Protection Board’s article: “Have Medical Debt? Anything Already Paid or Under $500.00 Should No Longer Be On Your Credit Report”, https://www.consumerfinance.gov/about-us/blog/medical-debt-anything-already-paid-or-under-500-should-no-longer-be-on-your-credit-report/
Several Other changes have been made by the credit reporting agencies that are pro – consumer. We shall continue to bring these matters to your attention, in hopes of mitigating the sting of medical debt.

Human Health Advocates has successfully provided assistance to consumers with medical debt for nine years. It’s founder, Kenneth Klein is a board-certified patient advocate. Mr. Klein has successfully negotiated resolutions to significant hospital debt more than one hundred (100 )times on a national basis. He has prepared numerous successful insurance appeals, reversing denials of coverage for medical charges. Contact Human Health Advocates for a free consultation if you have problems with hospital or other medical debt.

https://humanhealthadvocates.com
(561) 515-5313

Get Help with Medical Bills and Insurance Claims Our team at Human Health Advocates helps people resolve extremely high medical bills and denied insurance claims.

By law, everyone is entitled to one free credit report every 12 months from each of the three credit reporting agencies. In 2020, given the effects of Covid on the economy, the three agencies agreed to temporarily make free credit reports available each week. This was subsequently extended through the end of 2023.

Human Health Advocates always suggests that its clients check their credit reports. Sometimes medical debt has been posted without their knowledge, other times there is medical debt posted wrongfully—In such instances the blemishes on one’s credit report should be removed. Nearly 1-in-5 households in the United States has reported having some form of overdue medical debt. Patients and their families are contacted by debt collectors about medical bills more than any other type of debt, and it commonly results in negative information appearing on credit records. In fact, in 2021, 43 million people had allegedly unpaid medical bills on their credit reports.

Recently, credit reporting agencies made several pro-consumer changes regarding credit reporting of medical debt. First, medical debt under $500.00 is entitled to be removed. Sometimes medical debt is posted that discloses the name of a subsequent purchaser of the debt rather than the medical provider. If you see any medical debt listed on your credit report under $500.00, contact the reporting agency promptly and dispute the posting to have it removed. Caveat: the removal does not apply to debt paid with a credit card.

The real and lasting damage often done regarding medical debt occurs when it is reported, subsequently paid off, yet remains on the patient’s credit report for a full seven (7) years. That is no more. Paid medical debt is eligible for immediate removal from the credit report. Accordingly, one should check their credit report for old medical debt that may have been resolved and seek to have it removed from their report.

Protect your credit score. You might have debt reported of which you are unaware. You might have medical debt that was paid off that remains on your credit report to this day. Don’t rely upon the credit reporting agencies to do everything correctly. They could easily overlook a reported medical debt that is entitled to be removed. Take a few moments and obtain and review your free credit. It could improve your credit score measurably.

To obtain your free reports, go to: www.annualcreditreport.com .

For a more comprehensive explanation, see the Consumer Finance Protection Board’s article: “Have Medical Debt? Anything Already Paid or Under $500.00 Should No Longer Be On Your Credit Report”,
https://www.consumerfinance.gov/about-us/blog/medical-debt-anything-already-paid-or-under-500-should-no-longer-be-on-your-credit-report/
Several Other changes have been made by the credit reporting agencies that are pro – consumer. We shall continue to bring these matters to your attention, in hopes of mitigating the sting of medical debt.

Human Health Advocates has successfully provided assistance to consumers with medical debt for nine years. It’s founder, Kenneth Klein is a board-certified patient advocate. Mr. Klein has successfully negotiated resolutions to significant hospital debt well over more than one-hundred (100) times on a national basis. He has prepared numerous successful insurance appeals, reversing denials of coverage for medical charges. Contact Human Health Advocates for a free consultation if you have problems with hospital or other medical debt.

Have medical debt? Anything already paid or under $500 should no longer be on your credit report | Consumer Financial Protection Bureau The nationwide credit reporting companies have removed medical collections already paid, under $500 or less than a year old from consumer credit reports. Have medical debt? Here’s what you should know.

Although Medicare no longer pays for at-home Covid tests that does not mean that they are still not important. The government has again made a limited amount available. Each home can order four (4) free tests. These are a valuable tool for early detection and monitoring, for letting people know to assist monitoring, and for letting us know when to isolate and protect others by wearing a mask. It is imperative that we look after ourselves and help protect each other against Covid. The free tests can be ordered from the Government’s website at: https://www.covid.gov/tests.

COVID.gov - Free at-home COVID-19 tests Every U.S. household is eligible to order 4 free at-home COVID-19 tests.

Human Health Advocates wishes a happy and healthy Thanksgiving to our clients, friends, business associates, families, and all involved in the provision of medical services or administration. Thank you. Stay safe!
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With great thanks we would like to acknowledge our appreciation for the many military personnel and their families that have contributed so much to this country. As well, we announce our appreciation for all first responders in the medical field, be they doctors, nurses, technicians, and everyone else fighting the war against Covid. Happy Veterans Day from Human Health Advocates.

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Human Health Advocates, the medical bill reduction specialists, wishes each of you a restful Labor Day. Please stay safe—and take a moment to think of how we can best help each other weather . Masks are recommended by the indoors for BOTH vaccinated and unvaccinated people in areas of high transmission. Make sure you research where you are getting and antibody tests. Some labs do not accept insurance. Others do not accept Medicare assignment(meaning you can be balance billed the difference). There is a Federal fund to pay for testing for the uninsured. Keep your records. And for those who have yet to be —the life you save could be your own, your spouse or partner, your parent, or your child. The will most likely save your life; probably even keep you out of the hospital if you do get sick. 99% of the people currently hospitalized were . That is a fact. The incidence of adverse side effects are minimal. Don’t end up on a ventilator hoping you survive and wishing you had been vaccinated. So—DON’T HESITATE-VACCINATE. Stay posted for information on booster vaccines. And remember, Human Health Advocates is here to help with your medical billing records. A five-plus year track record of successes.—simply—we resolve medical debt and health insurance issues. Contact us for your free consultation.
https://humanhealthadvocates.com

Despite CDC guidelines, prudence dictates continues vigilance against Covid--which is making a resurgence due to so many refusing to be vaccinated,among other things. Our employees are always masked when we meet in person--our conference rooms are thoroughly sanitized before each use.

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