My wife is legally blind with several complexed medical conditions.  Prior to 2014 she was in the medical field.  She held positions, such as, Director of Quality, Director of Case Management, Director of H. R., Director of Medical Services, Chief Compliance Officer, and CEO to name a few.  She has a Master’s degree in Hospital Administration.   Frances is very fluent in healthcare matters.  We moved to the DFW area in 2015.  My wife became seriously ill during 2015.  In 2015 we had a well-known insurance company with a PPO coverage.  During 2015 she had many tests run by several specialists.  At the end of 2015 our insurance coverage tripled in cost.  We were forced to seek another insurance provider.  A major insurance was available but only under a HMO.  Having this insurance company in the past but in the PPO capacity we felt our decision was appropriate.

At the beginning of 2016 my wife was seriously ill and had to have surgery.  HMO’s require referrals prior to having lab work, x-rays, inpatient visits, and surgeries.  If these services are not referred from your primary care provider (PCP), the patient is responsible for the EOB charges.  We had a PCP that’s office staff refused to refer my wife for testing.  Previously, my wife had a TIA.  At the beginning of the year my wife showed the exact symptoms of another TIA.  She was admitted into a well-known owned hospital in our network.  She spent two and a half days in this hospital. Three days after discharge we received notification our hospital stay was not covered.  We contacted the insurance company through their patient advocates department for a reason why we were denied.  We were told not to worry about it and to call back in a month.  We contracted the patient advocate department again and were told a different story.  We were given instructions to call a doctor and tell him to call the insurance company and the hospital’s billing department. We did all they asked.  The doctor refused to talk to us. The hospitals billing office refused to assist us.  We called the CEO of the hospital with no return call.  We called the hospital’s patients advocate five times without receiving a call them either.  Meanwhile my wife was diagnosed with another TIA.  We continued to contact this well-known insurance company.  While being told something new each time we contacted them however, their employees began telling us to contact the Texas Commission of Insurance to file a complaint against this huge insurance company.  We were told that once we started the appeals process we had 180 days to appeal, then days later we were told we should have started the appeals process earlier, just as soon as the Insurance Company denied the claim.  The insurance company used up over 90 days of the appeals process.  While this was all going on my wife became weaker and weaker.  Again in four months she had another TIA.  I had to find another PCP that would help my wife.  We finally found a PCP that would refer to the specialist she needed.

The new PCP insisted I search the internet to find a patient advocate.  We tried to contact just a few but they did not know the Texas regulations on insurance issues.  Just ten days before our appeal process was up we found a doctor who was a patient advocate.  A doctor!  All others we found were LVNs or RNs.  We called Dr. Vik Rajan immediately.  My wife and I talked to him about the nightmare we had been dealing with.  He asked us to come to his office in Houston.  Our hearts sank.  Broken hearted we said, “We live in the DWF area.”  He said, “No problem.”  Dr. Vik Rajan asked us to send him what we had.  We had our conversations with the insurance company, the documentations with the insurance company, our documentations with the Texas Commission of Insurances, what we had of the medical chart, and the documentation of the discharge.  Within one or two days he called and said he believed we could win this.  That was music to our ears.  Within days Dr. Rajan called and told us that the $42,000.00 was no longer an issue for us.  What a life saver.  We live on a fixed income and that $42,000.00 would had caused us to file bankruptcy.

We are now discussing becoming a member of his Houston Patient Advocacy’s holistic health coaching system to assist my wife with her severe autoimmune diseases.  If you have similar problems with medical issues we urge you to please contact Dr. Vik Rajan to see if he can help you.  He is honest, professional, compassionate, knowledgeable in insurance billing, and is a doctor who cares.  His Mission Statement revolves around his love and pitfalls he witnessed during his mother’s battle with kidney disease.  His compassion is evident

I wanted to take a minute to thank you from the bottom of my heart for all your help. I broke my leg over a year ago at a time when my insurance had lapsed, and one trip to the hospital and one surgery later, I was facing close to $80,000 in medical bills. Because I was injured in a different county than I was residing, I was not qualified for any of their programs, and because I was injured outside of my own county, I was not qualified for any of theirs. Because I did not have any children or dependents, I did not qualify for any help, and I had no idea what to do with bills of that magnitude.

It was really intimidating to talk to billing departments on my own, and they would flat out tell me they could not negotiate anything and would not take small payments, and I was at a complete loss. It is completely humilitating hearing someone tell you “tough luck” when faced with such a bill because you happened to injure yourself a few miles outside your county and you happen to have no children. I couldn’t work anymore and was unsure how to handle a second surgery when my new insurance would not cover my “previous condition” of my leg and I hadn’t even paid for the first surgery and needed another.

I found Houston Patient Advocacy online and gave it a shot. I contacted Dr. Rajan who put me in contact with a billing expert, and working together with them was such a relief! They knew what I was going through, and I can’t tell you what an amazing feeling it was to have someone speak on my behalf and stick up for me and realize there were possibilities I had no idea about because I had been previously told there were none. It took perseverance and lots of paperwork and refusing to give up, but I couldn’t believe it when I received a bill from the hospital that had reduced my hospital stay from $72000 to $3400. After that, they sent a letter of acceptance which I sent to the other bills and was immediately approved for assistance as well.

I don’t know the long-term solution for fixing our entire healthcare here, but I can tell you that hiring a patient advocate was the best decision I ever made, and now I don’t have a huge looming bill hanging over my head for the rest of my life. It is like 500 pounds dropped off my shoulders. Thank you so much!

In February of 2013, I collapsed from an intractable migraine and could no longer work at my job until I could find a doctor that could help me. I filed a short-term disability claim with my insurance provider, Cigna, and I was denied after a month into my convalescence. It took several months to get in to see a renowned headache specialist at The University of Texas Medical Center in Houston after seeing many doctors for a solution to my painful, daily migraine. After my treatment and improvement, I filed an appeal with Cigna for disability payment for the six months that I was unable to work. My insurance appeal was denied a second time because it was difficult to prove my functional loss and inability to work due to the nature of my illness. After returning to my job in August 2013, I began to contact several attorneys for assistance. The few attorneys that would have taken my case on contingency would have taken almost half of any compensation I received. Fortunately, at this point I found and contacted Houston Patient Advocacy. Dr. Vik Rajan, M.D. contacted me immediately to discuss my case. He was always positive and gave me hope that we could have a favorable outcome to my dilemma. Dr. Rajan effectively communicated with all my doctors and retrieved important documents and information to support a new appeal. He submitted a third appeal on my behalf which was written with his medical expertise and insight into the complicated insurance processes. I am happy and relieved to tell you that thanks to Dr. Rajan, my appeal denial was reversed and I was immediately awarded a check of nearly $18000 for my six months of disability pay. I am forever grateful to Dr. Rajan and Houston Patient Advocacy.