03/06/2025
Patient advocacy is a term that’s been circulated through medical circles for some years now, and its meaning is fairly intuitive: helping patients navigate through the nebulous and confusing myriad of healthcare-related obstacles. I became the legal guardian for a family member last year, and one of my first tasks was to re-enroll them in their Medicare supplemental plan through United Healthcare that had dropped off. I noticed there was a denied claim during the period they weren’t enrolled and looked into it further. A doctor’s office that had performed a preoperative clearance exam had billed UHC for the labs they had performed, and the billed amounts were astronomically high: nearly 5800% above the fair-market price! Now most people who receive such a bill will get bowled over, but they’ll relent and say “well, that’s just healthcare” and pay the full amount without question! Do you really want to pay $700 for a test that costs $5.00?
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This is where having a patient advocate will save you THOUSANDS of dollars. Little did United Healthcare know that they’d have a seasoned Direct Primary Care physician appealing this bill on their patient’s behalf, let alone with numerical data detailing the disparity in their valuation of these labs. Notice on the final page of UHC’s letter where it says “You have the right to appeal our decision”. For any medical expense, whether it’s an MRI, labs, a surgical procedure, ANYTHING… you have the right and the ability to appeal and negotiate the charges. However, doing so often feels like representing yourself in court, it’s your word versus theirs. That’s why Direct Primary Care physicians are worth their weight in gold. We help provide patients with multiple avenues to save money and avoid frivolous, inflated charges such as these. We’ll do a follow-up post with UHC’s response so you can see how this appeal pans out.
