After 25+ years experience in the medical billing/collection field, it has become clear and apparent to me that many people find insurance claims, doctor's bills, insurance company denials, referrals and appeals very confusing, time consuming and costly. Often a patient will simply pay a bill he/she receives when, in fact, it should have been paid by their insurance company.

My name is Susan Doerner and I have been a resident of Park Ridge, NJ for over 35 years. I KNOW how to deal with medical insurance companies. I am aware of their tactics and the games they play and who suffers- YOU, the patient! I can help.

Here are two examples:

My father-in-law entered a re-habilitation facility several years ago. He had Medicare and supplemental insurance as well. I was his Power of Attorney at that time and met with the Director at this facility the day he was admitted. He assured me that as long as he did not stay beyond the "allowed" 6 weeks that he was fully covered. My father-in-law left this facility in 5 weeks as he had to be hospitalized for a medical issue. I received a bill in the amount of $6,000. One letter from me to the Director and the bill was written off. How many people would have paid this? Not knowing that, in its own way, this is a form of fraud.

My son saw a dentist for major work ($6,200). He had dental insurance and knew they would pay poorly so he paid $2,000 to the dentist upfront, waiting to see what insurance would do with the balance. An entire year passed and my son began to receive threatening letters stating that he now owed the balance as his insurance company paid nothing. I followed up and discovered that the dental office mailed the claim to the wrong insurance company! They then resubmitted the claim to the correct company, but it was denied due to "untimely filing". One letter from me to that dentist, pointing out that the fault was with his staff billing person and not my son, and that bill was written off.

Medical insurance today is very confusing. Each company has many different policies—HMO, PPO, Indemnity and so on. Some plans require referrals, some don't. Some require precertification for the simplest procedure or test, while others don't. Staff in physician's offices are extremely overworked these days with all of the phone calls and paperwork that is required that many things are overlooked by them and the patient suffers. This needs to STOP!

The initial appeal should be made to the insurance carrier by the physician's office. This does not usually work. Insurance companies take a "member" appeal far more seriously. However, an appeal letter must be well written. This is where I can help. Naturally, I will require as much information as possible from you, the patient. I will need things like copies of insurance denials, bills from doctors, dates of service, copy (front and back) of your insurance card. At that point I would write a letter of appeal for your signature and it should always be sent certified mail. I don't give up after merely one letter—as many as three appeals are often necessary.

When I feel it necessary to phone the insurance company on your behalf, they will require a form filled out by you called a "request for personal representative". This is easily obtained by calling the number on your ID card and requesting this form. Once you fill out that form, sign it and mail it back to your insurance company, they will have it in their computer and I will be able to discuss your case with them.

I offer a FREE INITIAL CONSULTATION to be sure that you have a viable case and that I have all the necessary information to "go to bat" for you. If I agree to take your case on, my fee at that point is $50. If I win the appeal my fee is 10% of what you do not have to pay or what you get back from your carrier. Insurance is convoluted and difficult to navigate. Countless people pay medical bills every day without scrutiny. Don't let this happen to you.

Please visit my FAQ page for more information.