MONROE—Adria Goldman Gross, a resident of Monroe who grew up in Port Jervis, started her career as a health advocate after a fall down some restaurant stairs in 2001.
It wasn’t her that fell but her first client, a 68-year old man who had been in a wheelchair for most of his life due to polio and who broke both legs in the fall.
He sued the restaurant for failing to make their building handicapped accessible and years later, won the lawsuit. Medicare claimed part of the damages owed to him for the hospital bills he incurred from the accident, but when they sent him a 28-page bill, he knew they were asking for too much.
“The first five pages included the doctors names and just looking at that I knew immediately that there was stuff that didn’t belong there,” he said in a phone interview.
They had included procedures like colonoscopies, a fishhook in his hand, and bills from his eye surgeon, which were not related to his accident.
“It was like reverse Medicare fraud,” he said.
Goldman Gross, who had worked for two health insurance companies: AIG and Access America, as well as for a doctor, was just starting her medical billing business Medwise Billing, when Dunitz asked her to help translate the prescription codes on his bill.
What Goldman Gross discovered is, like Dunitz suspected, they were asking for reimbursement for things he never had. When all was said an done, Goldman Gross saved him $86,000.
“And when I realized I could do this,” she said, “That’s when I thought ‘I need to open up another type of business.’”
In 2012 she opened up MedWise Insurance Advocacy, a division of MedWise Billing, Inc. with the logo “We give a hoot about your claims.”
Health Advocacy
The idea of a health advocate, or someone who has the knowledge and skills to navigate a client through the maze of insurance jargon and roadblocks, is still fairly new.
