By Mary Daniel
CEO, Claim Medic
My first job after college was with Jacksonville plastic surgeon, Lewis Obi. Dr. Obi needed a medical biller and I needed a job, so in March 1985 my medical insurance education began. After many years of learning the ins and outs of medical billing, I have been able to help family and friends when they need it the most. After my in-laws retired in the 1990s, I began auditing their medical bills. They had many, many hospitalizations, surgeries and doctor’s appointments, so I developed my own system to monitor all of their expenses. I used the system to ensure their insurance company paid properly and they were being billed accurately by the providers.
My personal experience with medical claims and the frustration and headache they can cause became even more evident when my husband was diagnosed with Alzheimer’s disease three years ago. We’re extremely fortunate to have world-class medical care in our back yard, but I was quick to learn that great medical care doesn’t translate into accurate medical billing. In fact, the prominent organization that provided my husband’s care made frequent billing mistakes!
For example, we had United Healthcare coverage through my husband’s employer. Thankfully, the entire medical organization was in-network, or so we thought. We received a bill for $3,000 after my husband had a neuro-psych evaluation with a psychiatrist who was out-of-network. After months and months speaking to everyone at the medical clinic and the insurance company, they finally agreed to write off the $3,000. My argument was simple: if they had not credentialed a provider to be in-network like everyone else in the group, that was their problem, not mine! Plus, we were never told any of this upfront, before services were rendered. It took some time but they eventually agreed!
Even after years in the medical insurance industry, I experienced the frustration and helplessness first-hand and learned how exhausting it can be to fight for what is right! It made me realize that patients and their families need help when they have to deal with these types of situations. I knew I could help others save money, time and frustration by becoming their patient advocate, and that’s how ClaimMedic was born.