Simplified Health Plans

Hospitals and Health CareUnited States2-10 Employees

CONNECTING PATIENTS TO CARE
Simplified Health Plans is an independent patient centered consulting firm that helps consumers in gaining access to, and payment for, quality healthcare. That is, we provide advice on health coverage. 
•	Recommend to consumer best available value in health coverage. 
   o	Evaluate coverage options from private insurance, foundations, free and charitable clinics, or public programs (including Medicare and Medicaid).
   o	Assess provider directory and prescription drug formularies for best fit to patient needs.
   o	Counsel on plan quality, service, and financial stability.
   o	Educated on total costs including premium, “cost-sharing”, non-covered services, and penalties for not complying with plan rules.
•	Researched topics, authored news articles, served as a source for reporters and gave presentations and testimony. 
•	Enrolled patients into coverage via the Affordable Care Act (ACA).
•	Filed appeals and grievances.
•	Negotiated fees and payment terms using Medicare’s RBRVS and state-specific Medicaid fee schedules.
•      Resolved billing and coding issues. 
• 	Negotiate with managed care companies to authorize and cover needed services; resolve issues with the hospitals or physicians fees, payment terms, and billing issues. 
• 	Resolve grievances, complaints, appeals, and other issues.

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