Claims Advocacy

About This Coverage

Claims Advocacy

Claims advocacy is the test of whether your broker actually works for you. Carriers deny claims, bills come in surprisingly high, and out-of-network designations show up where they shouldn't. The carrier customer-service line gives you the same scripted answer every time.

Our job is the opposite: read the claim, identify the actual problem, call the carrier with you, ask the right questions, and stay on the case until it's resolved. Most resolvable claims get resolved.

What's included

• Direct review of denied claims and EOBs
• Three-way calls with the carrier
• Appeal letter drafting and submission
• Out-of-network and balance-billing escalation
• Carrier-level escalation when first calls fail
• Followed through to resolution, not handoff

When this is the right fit

• A claim was denied that should have been covered
• A bill looks wildly higher than expected
• An in-network provider was billed as out-of-network
• A prior authorization was missed or delayed