Medical Insurance Advocacy Training

24 Lessons

8 Videos

All

Skill Level

5:51:17h

Duration

English

Language

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Overview

This comprehensive medical insurance advocacy training program has been developed by Adria Gross of MedWise Insurance Advocacy, drawing on her 25+ years of healthcare experience and the success of her New York-based practice founded in 2006.

Completing this course will help you:

Analyze medical bills and identify common errors and overcharges
Navigate insurance policies and interpret complex coverage language
Negotiate effectively with healthcare providers and insurance companies
Manage appeals processes for both internal and external reviews
Communicate professionally with clients, providers, and insurers
Build and market your practice
Review your own denied medical claims and negotiate better
Help yourself, your parents and children with their medical claims needs

Who is the course for?

This course is designed for:

Healthcare professionals transitioning to advocacy
Insurance industry professionals seeking specialization
Legal professionals needing medical billing expertise
Entrepreneurs interested in healthcare advocacy business
Current advocates seeking comprehensive training
Anyone who wants to negotiate their own medical bill denials and inaccuracies
If you’re caring for a parent who’s claims are being denied and owe thousands of dollars

Learning Path

Module 1: Foundations of Medical Insurance Advocacy

Understanding the inherent complexity of the U.S. healthcare system
Why patients need help: Key drivers of demand (cost, errors, denials, time burden)
Market need and growth potential overview
Medical Billing Advocate: Focus on financial accuracy and cost reduction
Insurance Claim Advocate: Focus on policy interpretation and maximizing benefits
Patient Advocate: Broader role including care navigation and support
Understanding overlaps and distinctions
Overview of key services: Auditing, Negotiation, Appeals, Financial Aid Navigation
Ethical considerations: Acting in the client’s best interest, transparency, confidentiality

Video 42:43 Min + Worksheet + Audio

Module 2: Medical Billing & Coding Essentials

Dissecting hospital bills, physician statements, and itemized lists
Understanding the Explanation of Benefits (EOB) from insurers
Introduction to CPT, ICD-10, HCPCS codes, and modifiers
How codes translate services into billable items
Identifying duplicate charges, unbundling, upcoding, incorrect codes, charges for unrendered services, etc.
The high prevalence and cost of medical billing errors
Hands-on practice reviewing sample bills and EOBs for errors

Video 40:53 Min + Worksheet + Audio

Module 3: Navigating the Insurance Landscape

Understanding PPOs, HMOs, EPOs, POS plans
Medicare, Medicaid, and ACA Marketplace plans overview
Interpreting coverage details: benefits, limitations, exclusions
Understanding cost-sharing: deductibles, copayments, coinsurance, out-of-pocket maximums
From provider submission to payer adjudication
Common reasons for claim denials beyond billing errors (e.g., medical necessity, excluded service)
Understanding the process and common pitfalls
Advocacy strategies for securing necessary approvals

Video 1:26:43 Min + Worksheet + Audio

Module 4: The Art of Negotiation and Appeals

Preparing your case: research and documentation
Strategies for negotiating with providers (hospitals, doctors)
Strategies for negotiating with insurance companies
Negotiating discounts, lump-sum settlements, and payment plans
Analyzing denial codes and reasons
Gathering evidence and building a strong case for appeal
Internal appeals within the insurance company
External reviews and independent dispute resolution (IDR)
Patient success rates in appeals
Understanding and applying the No Surprises Act
State-specific surprise billing laws and other protections

50:32 Min + Worksheet + Audio

Module 5: Legal, Financial Aid, and Compliance

Hospital charity care programs
State and federal assistance programs (SHIPs, CAPs)
Pharmaceutical Assistance Programs (PAPs)
Understanding HIPAA regulations and patient confidentiality
The patient’s right to access records and receive itemized bills
Overview of key federal and state regulations impacting billing and insurance
Understanding ERISA basics (for employer-sponsored plans)
Identifying situations requiring legal expertise (e.g., bad faith denials, complex litigation)

43:12 Min + Worksheet + Audio

Module 6: The Advocate in Action: Process & Communication

Gathering essential patient and case information
Establishing scope of work and managing client expectations
Requesting and organizing medical records, bills, EOBs, correspondence
Maintaining meticulous records of actions taken
Strategies for clear and effective communication with clients
Professional communication with providers and insurance representatives
Tracking deadlines, follow-ups, and progress
Strategies for bringing cases to a successful resolution

29:40 Min + Worksheet + Audio

Module 7: Launching Your Advocacy Career/Business

Operating as an independent advocate vs. joining/starting a firm
Choosing a niche or specialization (optional but recommended)
Understanding different fee models: Hourly, Flat Fee, Contingency (% of savings)
Setting competitive and transparent rates
Identifying your target market
Networking and referral strategies
Essential software and tools for advocates
Understanding the role of AI in billing/claims and how advocates can use tech

28:26 Min + Worksheet + Audio

Module 8: Staying Ahead: The Future of Advocacy

The impact of AI on claim denials and the advocate’s role
Monitoring legislative and regulatory shifts
The growing focus on health equity in advocacy
Importance of continuous education and staying current
Resources for ongoing professional development
Connecting with other advocates, professional organizations (e.g., PACB, ACAP)
Finding mentors and resources
Review of key learnings
Action planning for launching an advocacy career

28:26 Min + Worksheet + Audio

What people have Said About Adria

I'm so thankful that I found Adria! Personable and caring, she was immensely helpful and effective in helping me successfully resolve a surprise hospital bill for almost $6000 for two standard outpatient tests. Her knowledge and expertise were instrumental in allowing me to dispute the charges confidently. The end result was I owed the hospital nothing. Highly recommend!

Thank you Adria for doing such a great job! It was so frustrating being double charged for an 'out of network' anesthesia bill. We knew nothing about the 'out of network' part. To think this company did this regularly and ruined people's credit scores when they didn''t pay. I was amazed at how quickly you got them to drop the bill to something far more reasonable. Your knowledge and expertise saved us $2000! We will call you again if we ever get stuck in a situation like that again. Thank you!

Adria is sincerely concerned about helping her customers. She's seen the ins and outs of the medical billing world and is passionate about seeing people get fair treatment. I can personally attest to how wonderful Adria's services are, and the concern she has for people. Would recommend her any day.

This amazing woman took the time to respond to my email, called me and gave me all the local contacts I needed to get my medical bills and insurance hassles solved following my husband's colonoscopy. We had tried to work with the insurance company and medical providers for months and were like hamsters on a wheel until we were lucky enough to find this lady. Thank you! Thank you! Thank you!

I hired Adria's services for a large hospital bill that was declined by the insurance company. After a few weeks of calls, emails and her relentless perseverance with the insurance company, we finally got paid. She is amazing and without her help we would never gotten paid by the insurance. She knows the inside works and knows how to approach the issue to have it resolved properly. I highly recommend her services.

Adria Gross is terrific. I sought her advise about some denied insurance claims I had and in less than 5 minutes she cut through all the noise with an insightful assessment and plan for what to do. She knows her stuff. Her book is well written and filled with useful tips.

Medical Insurance Advocacy Training

24

Lessons

8

Videos

All