Healthcare Advocacy & Expert Witness
Getting the Right Care at the Right Time and Place brings about the Right Outcome!
Peak Performance Plus Health Care Advocacy and Case Management services are designed to help insurance beneficiaries and their families with obtaining quality medical and behavioral health care at affordable rates; improving outcomes of the their care and quality of their life. This service also assists facilities and providers to obtain easy access to credentialing, appeals of denials of claims and the grievance processes which are different for each insurance company.
Are you, the beneficiary, having difficulty getting referrals, authorizations and claims approved by your Primary Care Physician and/or your Health Care Insurance Company? Are you, the Provider or Facility, having difficulty with healthcare authorization, determination of benefits and claims resolution with your patient’s Health Insurance Organizations? Miriam Sterk, LCSW, is the Healthcare Advocate who can help you resolve all of these issues and more!
Ways that Peak Performance Plus can Help
Help with an appeal of Enrollment or Re-enrollment: if you miss the enrollment period, you may be excluded from insurance coverage or from having an option to change any or all of your benefits
Help with navigating the Grievance and Appeal processes. Most Insurance companies require preauthorization of services. If this process is not completed to the specifications of the benefit as written in the policy, there will be a denial of coverage for the beneficiary and provider. for the service. This type of situation can be costly to both the beneficiary and provider.
Help with coordination of Long Term Care Insurance and secondary insurance benefits with local community resources facilitating a seamless transition from hospital to rehabilitation center and home care.
Help in assisting in the process of filing a Request for a Waiver on a policy which would allow the beneficiary to be covered by the policy for exhausted or non-inclusive services avoiding the beneficiary being held responsible for out of pocket payment of such services.
If you or anyone you know has any difficulty in obtaining service for their healthcare needs, contact Miriam Sterk LCSW C-ASWCM at Peak Performance Plus. Get the Right Care at the Right Time and Place brings about the Right Outcome!