Our Specialized Advocacy Services
We bridge the gap between complex healthcare systems and patient financial well-being through expert auditing and professional representation.
Medical Bill Auditing
The Forensic Deep-Dive into Billing Accuracy
Medical billing is a complex language of over 70,000 ICD-10-CM diagnosis codes and nearly 10,000 CPT procedure codes. With roughly 80% of bills containing errors, a passive review is not enough—you need a forensic audit.
CPT & ICD-10 Verification: We perform a line-by-line comparison of your medical records against the codes billed to identify 'upcoding' or 'unbundling'.
Identification of Duplicate Charges: We scan for administrative rework where hospitals may have accidentally billed you twice for the same service.
Demographic & Clerical Error Detection: Since nearly half of all denials stem from simple data entry mistakes, we verify that your name, DOB, and insurance ID were keyed in correctly at the point of service.
Hospital Compliance Review: We ensure the provider has followed federal Price Transparency rules, which mandate that they publish their 'standard charges' online.
Insurance Appeal Support
Professional Advocacy in the 'Denial Maze'
An initial insurance denial is often just the beginning. FairCare bridges the gap by acting as your Authorized Representative during the difficult appeals process.
Clinical Justification & Appeals: We draft formal Level 1 and Level 2 appeals, working between your physician and the insurance payer to provide clinical documentation.
Prior Authorization Resolution: If a claim was rejected because a doctor failed to get pre-approval, we step in to retroactively prove necessity.
Benefit Coordination: We resolve disputes where primary and secondary insurance companies both refuse to pay.
Network Adequacy Challenges: If no in-network specialist was available, we leverage Network Adequacy laws to get the bill covered at in-network rates.
Negotiation Services
Strategic Financial Resolution and Debt Protection
Once a bill is accurate, we shift to financial advocacy to reduce your liability.
'Fair Price' Anchoring: We use data to benchmarks a cash settlement.
NJ/NY Legislative Lever: We cite laws like the NJ Louisa Carman Act to protect your credit.
Financial Assistance Qualification: We screen against state-mandated income thresholds to force hospitals to waive debt.
Interest & Payment Plan Defense: We leverage the interest caps in New Jersey and New York to ensure affordable resolution.
Our Proven Advocacy Process
PATH TO RELIEF
We simplify the complex world of medical billing through a structured, transparent methodology designed to recover your savings and protect your peace of mind.
Intake & Policy Review
We gather all Explanation of Benefits (EOB) statements, medical bills, and insurance policies to establish a complete timeline of your medical journey and identified stressors.
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Forensic Bill Audit
Using specialized clinical auditing tools, our experts perform a line-by-line analysis to identify coding errors, duplicate charges, and upcoding violations that inflate your liability.
Precision Advocacy
Leveraging a 20-year background in high-stakes service at Delta Airlines, we use focused negotiation tactics to challenge improper bills directly with hospital administrators and insurers.
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Resolution & Savings
We secure formal confirmation of your debt reduction and provide a full savings report. We verify that your medical credit is restored and the case is closed fairly.