Far too many people face a debilitating illness such as cancer, Lyme disease, or other conditions that require more energy than normal to fight and endure treatments. But unfortunately, they also face a need to maneuver through the complexities associated with a very complicated insurance and health system. Long-term or grave illnesses often involve recommended treatments that are not covered by insurance or seeing providers that are out-of-network. Or, perhaps conventional treatments and medications are not working. As a result, some patients are seeking alternative, holistic, or naturopathic treatments. However many of these treatments, both overseas and within the U.S., require payment upfront.
As the need for medical help continues and the complexities of dealing with insurance companies becomes an epidemic, more and more patients need someone to help them evaluate every aspect of their hospital stay, possible treatments, and appointments. Not just any help, but someone who will evaluate and assist in the preparation of those billable medical expenses for reimbursement.
Alexander Lopera realized the need for this service. With years of experience working within the insurance and health fields, he founded AMHA - a company that helps remove the stresses of dealing with insurance companies from those who need to save their energy to fight their illness.
The Alternative Myth
Patients are under the assumption that treatments received at alternative clinics are all non-approved; however, that is not the case. Ancillary services such as lab tests, radiology, diagnostic imaging, consultations, and more, are billable services. AMHA has a team of billing experts who will thoroughly review a patient’s medical bill to identify which aspects of their treatment and medical care are billable. However, each item needs to be properly coded in accordance to rules set forth by the American Medical Association.
In addition, some facilities will give patients a basic bill with a few codes. Thinking that this is enough, the bills are submitted to the insurance company, hoping for a reimbursement. But, when it’s insufficient, as it often is, it will either be delayed or denied. AMHA has worked with providers to help them create a billing template that itemizes the various treatments a patient receives so a claim is submitted with all the necessary information to properly process it.
How the Process Works
Prior to treatment, perspective clients can complete an AMHA patient information form, and then return it to AMHA’s office so it can be evaluated by the trained staff, free of cost. Even though they cannot make any guarantee of coverage, they will have a much better understanding on what coverage the patient may or may not have after evaluation. With this valuable information, they can then instruct you in the best manner to proceed.
After the treatment, the patient will submit a completed AMHA patient information form, along with the medical bill and proof of payment to AMHA’s office. Upon receiving the completed paperwork, the billing staff will determine which treatments and services provided are FDA approved. They will then note them with the appropriate codes and submit the claim for processing. The claim will be followed by AMHA throughout the entire processing stage, until a final decision is made.
How AMHA Benefits Patients
With the help and expertise of AMHA, many patients can now afford to receive more medical care, due to successful reimbursements by the insurance company. Working on a contingent basis, AMHA will only get paid if they can obtain a reimbursement for a patient. So, there is absolutely no risk in utilizing their professional services.
Here are some of the services AMHA provide:
- Free verification of patient insurance benefits
- Professionally and accurately prepared coded claims
- Certified CPT/ICD10 coders
- Electronically submitted claims
- Secondary insurance billing
- Insurance follow up in a timely manner
- Level 1 appeals
Alexander Lopera has over 20 years of experience, and has an experienced and dedicated team to help you in your needs. If you feel as though you could benefit from AMHA’s team, or want more information, give them a call at (281) 580-1423 or visit www.amhabilling.com.