Navigating the health insurance bureaucracy can be a very time consuming, frustrating and often difficult task. For individuals diagnosed with mental health illnesses, the process can be even more challenging. Dragonfly Transitions recently learned of Scott Leshin and have a current family that works with him. Scott Leshin, Founder and President of SJ Personal Healthcare Advocates (SJPHA).

SJPHA breaks down the bureaucracy to ensure individuals receive the benefits they are entitled to from their health insurance provider. Scott Leshin, founded SJ Personal Healthcare Advocates six years ago out of the needs for his own son. Over the past six years SJPHA has helped numerous individuals receive benefits from their insurance providers for services such as Acute Inpatient, Residential Treatment, Partial Hospitalization, Intensive Outpatient, Transition Programs and stand alone therapies including psychiatry and psychology visits.

How the process works:

SJ Personal Healthcare Advocates proceeds as follows:

• Obtain from the client their Summary Plan Description to review benefits.
• Obtain HIPAA Authorization from insurance provider and treating facility to allow SJPHA to speak on behalf of client.
• Review of level of care criteria provided by client’s insurance plan.
• Review of provider’s invoice and denial letter if one has been received by client.

SJPHA will determine next steps depending on where in the claims submission process each client stands and take a hands-on approach by.

• Managing the process allowing clients to focus on treatment.
• Speaking directly with the treating facility, insurance provider and treating doctors as needed to ensure accurate and timely reimbursement of claims.
• Updateding/Correcting Claims or Appeals if need be are done with as little client involvement as possible.

SJ Personal Healthcare Advocates LLC gets compensated on a contingency basis. If SJPHA does not get clients reimbursed from their insurance provider then they do not get paid for their services.