Personal Services

Benefit Defender is proud to provide the following affordable services to assist clients and families with their health insurance benefits and healthcare needs:

Claims Management and Processing

Benefit Defender Health Benefits Specialists understand the complexity of the health insurance industry. Clients can face the loss of time and money dealing with health insurance companies on their own. Benefit Defender Health Benefits Specialists can organize, file and manage your medical and prescription claims information saving you time, money and frustration.

  • Review health insurance policies to determine the extent of coverage
  • File and organize health insurance paperwork
  • Medical claims management and financial accuracy claim review
  • Manage ongoing claims for patients with special needs, chronic or serious acute conditions
  • Medical claims management for estate cases or bankruptcy cases
  • Communicate with service providers and insurance companies to resolve claim disputes
  • Negotiate with bill collectors to avoid collection notices
  • Medicare claims processing and management with Medicare supplement plans
  • Medical and prescription claims management with Medicare Set-Aside arrangements

Appeals

Benefit Defender Health Benefits Specialists assist clients submitting complaints and appeals with health insurance underpayments, denials, and payment duplication. Professionally written appeal letters by our team of legal nurse consultants result in payers overturning more health insurance denial determinations.

  • Medical necessity appeals
  • Expedited or urgent care appeals
  • Prior authorization appeals
  • Predetermination/Precertification appeals
  • General insurance coverage denial appeals
  • Eligibility appeals
  • Social Security Disability coverage denials
  • Denial of claim payments based on Medicare Set-Aside arrangements

Medical Records Review

Benefit Defender Health Benefits Specialists have the expertise and professional knowledge to identify deviations from standards of care located in a client's medical records. Reviewing medical records helps identify medical insurance fraud and provider billing errors. Benefit Defender Health Benefits Specialists can review your medical records and provide a written report for you to analyze and take action.

  • Find, review, interpret and analyze all the facts located in your medical records
  • Formulate requests for updating incorrect medical records
  • Review records involving medical necessity determinations/prior authorizations
  • Workers compensation medical coverage questions and case review

Fraud Prevention

Healthcare fraud costs federal and state governments, insurance companies, healthcare service providers and taxpayers billions of dollars each year. Benefit Defender Healthcare Benefits Specialists can catch fraud before you become financially responsible for expenses that were not related to your medical care.

  • Alert clients for possible fraudulent billing practices
  • Medical and prescription claims review for medical insurance identity theft
  • Notify authorities involving potential medical insurance fraud
  • Assist with identifying medical and prescription insurance claims that were not related to your medical care

Insurance Exchange Resource Specialist

Benefit Defender Healthcare Benefits Specialists are provided ongoing training about law changes that impacts the delivery of healthcare for clients.

  • Provide resources for ongoing changes and implementation for the Affordable Care Act
  • Assist with claims payment based on the Affordable Care Act coverage guidelines
  • Collaborate with government agencies that might provide assistance for clients

For questions concerning how Benefit Defender can help you or to request a pricing schedule contact us for more information.