PATIENT GUARDS
MEDICAL BILL REVIEW AND RESOLUTION SERVICES
Why Patient Guards?
Action
Results
Value
Our fees are the lowest in the industry.
Others charge:
20% of saved amount $1,000 maximum fee
25% of saved amount
There is no fee to review bills under $100
Bills between $100 and $99 are $25 per review
Bills over $1,000 are a $50 fee to review.
For any paid review, if there is no change in the bill, credit is granted toward a future bill review.
Uninsured?
Ask about our Bill Aussurety Program
Ask about our Employer and Group Programs
Visit These Valued Leaders In Life and Health Needs
Bills
Physician Services
There are many elements to even the most routine of medical office visits that can create errors. From how the medical provider bills to how the insurance carrier pays.
If you do not have insurance, making certain that the billing is accurate is an addtitional concern for many so that they pay only the fair and appropriate fees.
Hospital
The knowledge of bills from hospitals is enormous. It takes professionals that work with these bills every day a great deal of time and experience to master. The average healthcare consumer is at a great disadvantage if they do not possess this extensive understanding of the complexities of hospital bills. This is true for both Outpatient and Inpatient services.
Diagnostic
Diagnostics include a wide range of services from laboratory testing to radiology and more. There are many factors that create the potential for error including medical nesessity, bundled services, authorization, coverage limitations, and more.
Ambulance / Transportation
The charges for transportation can range from emergency response to routine medical transport to and from medical treatment appointments. This is, again, a complex knowledge base that most consumers simply lack experience in or knowledge of the sources of guidelines on.
Other Services
There are many services that create additional challenges ranging from various therapy and counseling to additional billable or allowable services rendered at the same time as the services listed above. Be sure that you are only paying for those services that you are responsible for paying for and at the correct billable rate.
Benefits
Coverage Types
HMO, PPO, POS, ACO, and the list in the alphabet soup goes on. Each coverage type has its unique structure and each insurance carrier its own terms and conditions for each coverage type.
Terms and Definitions
Each insurance plan develops its unique benefits and terms of coverage. Even within the same insurance, coverage can vary by plan type, group, and other factors. This can understandably be overwhelming for the consumer.
Circumstances
A surgery such as a “nose job” or “breast reconstruction” may be covered or it may not be, depending on the circumstances. Cosmetic or restorative? Emergency or elective? It requires vast knowledge of the complex rules to reach a conclusion on appropriateness of billed charges as well as insurance payment accuracy.
Network
“But I used an In Network Provider”
This is a common exclamation. There are a number of root causes for errors. Insurance carriers records can be wrong. The provider ID may be mismatched. A related provider that bills separately may not be In Network (very common in Emergency Room visits).
Sorting this out efficiently takes knowledge of the many possibilities to arrive at the correct outcome.
Service Types
There are thousands upon thousands of different services that could possibly be billed for. Therapeutic or Exploratory? Screening or Diagnostic? Treatment or Prophylactic? Utilization Limits and the list goes on. It takes significant experience to navigate the complexities of types and classifcations of these services and the result can mean payment or non-payment of a bill.
Advocacy
Denied Claims
A denied claim will not fix itself. The denial reason must be identified and any remedy to have the claim paid will require a formal request for the claim to be reviewed. The wording and factual presentation of such a request will make the difference between succesful resolution and the claim remaining unpaid.
Coverage Appeals
Insurance carriers are not perfect and can make errors. They may also have some latitude for exceptions. An experienced Professional will have the best tools for a successful appeal.
Copay / Deductible
Cost sharing (out of pocket) comes in many forms. Varying copays based on service or provider type is one example. Some services are exempt from being applied to deductible. These are just a few of the areas where review may reveal errors.
Inaccurate Payment
Each medical service may have any number of charges for the same service. Think of booking a hotel room. There is the “rack rate” or standard room rate. There may be a government rate. An Auto Club or other special rate. Insruance carriers and Medical Providers enter into varying agreements in a similar way. A Medical Provider may gain a significant volume of business from participating with certain plans or coverage types and thus may agree to a specific billable fee based on such factors. An experienced Professional can validate the billed amount and resulting payment.
Other Issues
There are countless factors that can create bill errors. For example, the recently passed No Surprises Act and other regulations may require certain billing protocols and an error in obesrvance or application of regulations can result in discrepancies. This is not to say that the intent is sinister. Errors can occur quite innocently. Experienced Professionals are trained to assure that all is well and accurate.
Start a Review
Don’t let your medical bills create more stress.
Let us get to work reviewing them for accuracy now.
I don’t think I could have ever detected the error that Patient Guards found quickly. It may have literally taken me months or years to research and understand the data. Patient Guards had my bill corrected in just days.
I just knew that something was not right with my bill. I am an educated profssional in my field. That field is just not healthcare billing. I am glad I turned to those that are experts in the field.
What a relief! Fast, professional, accurate, and effective.
The founder of Patient Guards has decades of experience in the healthcare business. He has worked from coast to coast with some of the largest payers and health systems in the country. He has also worked in the backbone of the healthcare services, the smaller community medical practices.
Uniquely qualified having worked extensively in all parts of the process, he feels that healthcare consumers need advocates with the highest degree of knowledge and experience to help them navigate the complex fabric of healthcare billing.
The billing of and for healthcare services is challenging even for those that work within the field. From regulatory compliance and payer guidelines to tremendous differences between contracts, payment methodologies, and on must of course factor in that there is nothing that is perfect, and errors do occur.
Mr. Palmer has the depth of experience to lead his team of highly accomplished professionals in reaching accurate and fair results for all. Assuring that all consumers have the highest level of expertise working on their behalf. His team is expert at negotiating, when necessary, equipped with the empirical understanding of all stakeholders leading to resolutions that satisfiy all parties.
When you face a medical bill dilemma, the thing that you need most is knowledge and experience. That is in ample supply at Patient Guards.
Frequently Asked Questions
What are the fees for Patient Guards?
Bill review starts at $25 Annual Member Fee.
All initial reviews are free for Members.
For bills that have errors, a letter to the appropriate party responsible for the eror is $10. Each subsequent letter is $10.
Bills under $50, the initial letter fee is waived.
Additional fees may apply for services such as appeals or extensive research as follows:
Standard Appeal – $25
Complex Appeal – Starts at $50 after such action is explained and accepted by the client.
Other Fees –
Administrative fees (copying, document preparation, research, etc.) Begin at $5.00 up to the specified quote that is provided before such services are initiated.
Others offer FREE reviews. Why is there a charge for Patient Guards?
Our fees are always going to be lower and this is why. Others offer “FREE” reviews. However, they then charge a percentage of the savings with a minimum that is often quite significant.
If your review results in a finding that your bill is accurate, you will receive a credit for a future initial review at no charge.
One should exercise reasonable thought in this regard. To what extent will others go to offer a “free” review if it will not be significant enough for a client to pay the “minimum” fee?