All Posts

Weather is predictable. The cost of your care is not. It is in fact MUCH easier to prepare for a day on the northeast’s tallest peak than it is to forecast how much your care will cost.

IncitefulMed is an AI application that puts "Expert medical knowledge at your fingertips". As a professional patient advocate, I find it invaluable. Here's how it helped me win an appeal for one of my clients.

Once you know medical policies exist, the next question is almost always practical: how do I find the one that applies to me, and what do I do with it once I have it? Part 1 of this series covered the foundational layer: what medical policies are, how they sit alongside your other plan documents, and why they carry the same contractual weight as your actual plan contract. This post will describe how to find and use the medical policy to access care and use your coverage.

The prior authorization denial arrives. It says the procedure isn't "medically necessary." You pull out your benefits documentation or look online. The treatment you are pursuing is listed as a covered benefit when it is considered "medically necessary". So where are the specifics?

Prior authorization is not a one-time event. It's a process with a clock, a set of requirements you often can't see, and several places it can fall apart. The patient who follows up early and respectfully tends to get better outcomes. Hear's how you can work with your doctor's office to navigate this often frustrating process.

Navigating insurance coverage for knee gel injections takes patience, persistence, and a willingness to advocate for yourself. The process can feel overwhelming between prior authorizations, step therapy requirements, documentation demands, and the ever-present risk of denial. Understanding the landscape puts you in a far better position than going in blind. Work closely with your doctor's office, stay organized, ask questions, and don't take a denial as a final answer. If th

Vertical integration and consolidation in the healthcare industry results in higher healthcare costs for everyone.

Dealing with your health plan or health system’s customer service departments can be painful. Time wasted fixing mistakes and trying to get a straight answer can threaten your care and finances. Learn five strategies for making your experience more productive and less frustrating. This is the companion document to my YouTube video. Keep or save this for your use later.

Bariatric weight loss surgery has long been considered effective , so I was dismayed when I recently read about its relatively high denial rates If you or someone you know is on the path to bariatric weight loss surgery, then this post will help you plan, budget, and avoid problems. The key theme is effective management of the “long-game”; stay on top of the many steps during the months- and sometimes years- long process.

People often hate dealing with their health plans. I help them do just that for a living, so I see it up close. When I help clients on family plans, I often find that people overlook their plan role and permissions. Consider: You’re blocked from your teenager’s health information. You’re the family planner, but your insurer won’t let you complete an important task. You’re caregiving for an elderly parent or relative, but can’t access their critical information in a pinch. All