Hi—Kwame here. |
Today, I want to talk about a piece of mail. |
It's the one that shows up a week or two after your doctor orders something you need. A scan. A surgery. A rehab stay. A specialist visit. You've been waiting on it. And then the envelope comes, and somewhere in the middle of a page of small print is the word denied. |
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Maybe it's on your kitchen table right now. Maybe it's been there for three weeks because you don't know what to do with it. |
Here's what I want you to know: that letter is not the final word. It's the first move. |
The number that should make you angry |
Federal data shows that when Medicare Advantage denials get appealed, more than 8 out of 10 of them are overturned. The care gets approved. The "no" turns into a "yes." |
But only about 1 in 9 people ever files the appeal. |
Read that again. Most people who fight, win. And almost nobody fights. |
That's not because people are lazy |
I've heard from enough of you to know exactly why that appeal doesn't get filed. |
You're already sick, or you're caring for someone who is. The phone tree hangs up on you at minute forty. The form asks for records you don't have. Nobody at the plan will explain, in plain English, what they actually need from you. You call the doctor's office, they tell you to call the plan. You call the plan, they tell you to call the doctor's office. |
So the letter sits on the table. And the plan wins by exhaustion. |
That's the part that gets me. Not that the system says no — that it makes saying "wait a minute" so hard that most people give up before they start. |
There's a person whose entire job is this |
Most folks have no idea this exists, so let me say it plainly. |
You can be matched with a healthcare advocate — a real, named human being who takes the fight off your kitchen table and puts it on their desk. |
Not a call center. Not a chatbot. One person who learns your situation and then handles it: |
Appeals and prior authorizations — they file it, follow it, and push it Medical bills and prescription costs — they read the bill you can't make sense of and find what's wrong with it Appointments, records, and care coordination — the chasing, the faxing, the follow-up Plain-English updates — so you always know what just happened and what's next
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Our partner Baba does exactly this. Their advocates work with people on Medicare and Medicare Advantage in all 50 states, and they specialize in the situations where the paperwork never stops — kidney disease, cancer, Parkinson's, dementia, heart failure, chronic pain. |
And if you're the one doing all of this for your mom or your husband? You can start it on their behalf. Caregivers are a huge part of who they help. |
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Now the question you're actually asking |
What does it cost? |
Advocacy through Baba is covered by Medicare and by most Medicare Advantage plans. Most people pay nothing out of pocket. |
This is a benefit most Medicare plans come with, but many don’t know about. |
For comparison, hiring a private patient advocate on your own typically runs $250 an hour, and insurance doesn't touch it. |
Baba checks your coverage before anything begins. If they can't serve your plan in your state, they tell you up front instead of after you've signed up. And if something comes up that your plan doesn't cover, your advocate tells you the cost beforehand — not on a bill three weeks later. |
That policy is a big reason I was willing to put my name next to theirs. |
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How to get started |
It only takes about fifteen minutes. |
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Prefer to talk to somebody? Call 917-456-9002. |
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I've spent years teaching you the rules. An advocate is the person who runs them for you. |
Go get that letter off the table. |
— Kwame |
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P.S. If nothing's wrong right now, do me a favor and keep this email. The day a denial letter shows up, you won't want to go hunting for where to start. Bookmark it: callbaba.com/benefitsinsider |
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Benefits Insider has an advertising partnership with Baba. Baba and Benefits Insider are not affiliated with or endorsed by Medicare or any government agency. Baba is a private advocacy service, not a government program and not an insurance company. |
*View our Advertising Disclosure |
