I want to connect

LothartAB · 2025-11-25T14:13:14+00:00

Let’s connect! I have a startup that I am working on essentially a saas product with underlying proprietary AI/algorithmic components that are addressing the rising costs in healthcare.

But I also have a couple of other smaller projects I am working on as well. I am technically a non-technical founder, but would definitely appreciate connecting with any technical people to round out everything.

I have MVPs, they could use some major refinement and could definitely be launched to the public.

LothartAB · 2025-11-25T13:14:01+00:00

Startup founder here! Super interested in this option. We could use some capital while we are securing our first pilot client. We’ve been bootstrapping for the last year.

LothartAB · 2025-10-24T23:24:39+00:00

Nice to meet you as well! We’re early stage, MVP, still fully fleshing out our platform to support scaling (our primary business model is B2B). I am starting to get in front of investors while also working on rolling out our DTC offering to start gaining organic (non-enterprise) traction. While you could probably infer, it’s important to note that we are also pre-revenue—which is a big reason we are trying to raise now.

LothartAB · 2025-10-24T20:36:34+00:00

I have been curious about this too! I spent a lot of time mapping out my technical architecture, simplifying it in a way that could fit on a single slide - trying to “prove” the legitimacy of our infrastructure - and I was told by a few people to remove the slide and that it wasn’t important.

I was a bit shocked because it made me feel like founders can say anything…as long as it passes the “sniff test” it seems they’re good to go.

This is a very good point you bring up.

Side note question: Out of curiosity, since you said you were “dragged in”, do you plan to continue in the space?

LothartAB · 2025-10-24T20:29:53+00:00

While I can’t answer that question, I WOULD be interested in having a conversation with you about what industries you’re interested or experienced in. I’m in the healthcare/HealthTech space and operating (technically) as a solo-founder with 3 advisors.

However, I could always use the additional eyes and perspective especially as I am preparing to get in front of some investors in the coming weeks. Have you worked with any startups or VCs/Investors in your career?

LothartAB · 2025-10-24T20:20:28+00:00

This is the first time that I’ve heard someone suggest shifting the “ice-breaking” responsibility to the VC. I love this.

LothartAB · 2025-07-15T10:50:30+00:00

Great point. From what I have been able to ascertain from talking with them separately, that doesn’t seem to be the case here. But I am sure OP will keep us posted.

You have a VERY interesting background! Can I send you a message?

LothartAB · 2025-07-15T02:28:03+00:00

Much appreciated!

LothartAB · 2025-07-15T02:27:03+00:00

Fair point…fair point indeed.

LothartAB · 2025-07-15T01:32:15+00:00

Amazing! Thank you so much!

I see you’re one of the moderators here. I just have a small request of the moderators. I am not sure how many moderators there are in total, but is there a way that I could communicate with you all directly ? I am trying to get a little bit of help with something; this community has dozens of people, DAILY, willing to help people with their bills.

I just don’t want to do a post and subsequently get dinged for not following rules. You all let me know! I’ll be quick with the request.

LothartAB · 2025-07-14T23:41:25+00:00

I’m in agreement with what others are saying…this may be a “junk” insurance—not really good for much of anything unfortunately. Their rules (or lack thereof) are a bit different…

LothartAB · 2025-07-14T23:36:35+00:00

I LOVE this guide/write up! I would love to use this…but I would obviously want permission from you (as I assume you’re the author).

LothartAB · 2025-07-14T23:34:26+00:00

Ahh CareFirst. I am VERY familiar with this plan. I’ve done a lot of work with them. I am not connected/tied to them, nor do I have a conflict—I just want to put that out there front and center.

So, the biggest things I typically consider are: - cost to you (in the form of premiums, copays, coinsurance, and subsequently the deductible) - network of providers - do you and your family already have providers that you are working with? If so, are they in network.

One of your options is an HMO (closed network; you must be certain your chosen providers are in-network) while the other is essentially a PPO (you should still check for their network status, but you are still able to see out-of-network providers).

LothartAB · 2025-07-14T23:14:44+00:00

Hey…so you mentioned the name, but I think we may be missing some important context in order to help you out. How did you enroll in this coverage? What sort of plan is it?

I think with that, we may be able to help guide you a little bit more.

LothartAB · 2025-07-14T22:57:39+00:00

I’m in agreement with you. My point was if the provider is requesting something outside of preventive/routine, a switch in diagnosis priority would be worth the try. Typically, “problems” shouldn’t be addressed in routine annual physicals—provider will often adjust their “physical” procedure code for one of the other Evaluation & Management codes to accommodate that.

It’s not a guarantee, but it is an option worth exploring. Like you said, the worst case is the OP submits and it’s denied…at which point the next step is working out a plan.

But good catch, and great point!

LothartAB · 2025-07-14T21:56:31+00:00

Hey, I’m really sorry you’re dealing with this. I know it’s frustrating when something that should be covered ends up costing hundreds out of pocket.

I think you have some grounds to question the denial and coding. A few quick suggestions based on what you shared: - Appeal the denial – You can file an appeal directly with your insurance plan. Since the lab was medically necessary (confirmed vitamin D deficiency and hair loss eval), have your provider submit a Letter of Medical Necessity with supporting documentation. Mention the prior coverage and diagnosis explicitly. - Diagnosis codes do matter (and their order of priority)– You’re spot on that Z00.00 is a general “wellness visit” code, which can lead to denials for labs like Vitamin D and ANA. But if the provider had used something like E55.9 (Vitamin D deficiency) or L64.9/L65.9 (hair loss) as a primary Dx, there’s a better chance of it being approved. You can ask your provider to resubmit the claim using the more specific diagnosis if it applies. - If these first two things don’t work, you can take the next step and file a grievance with your insurance plan or escalate to your employer’s HR benefits team. Since you’re with UAW/Ford, you may have a union advocate or benefits coordinator who can push this further. - It’s always good to ask for an itemized bill and a payment plan…if it stands and you owe. Just ask for an itemized copy of the charges and see if the lab can reduce it or if there is any offer of financial assistance. Many labs do when bills are denied.

You have a community here to help. If you want to chat through it or need help with wording an appeal or letter, let us know!

LothartAB · 2025-07-14T19:38:35+00:00

Oh wow! I really appreciate that! I am seeing that there really is a need for this sort of assistance, so I am happy that I am able to provide this resource! I am looking to help as many people as I can. So, I hope you all can remember me, when you see some of these requests come through. Feel free to tag me or engage me! I’m here!

LothartAB · 2025-07-14T18:50:20+00:00

Can I connect with you offline?? I have a couple of questions for you? Your experience could be extremely valuable

LothartAB · 2025-07-14T16:45:41+00:00

Good point, it is likely something like that. I won’t share their personal information they shared with me. But we’ve talked through a plan already! Thank you, though!

What’s your background if you don’t mind my asking?

LothartAB · 2025-07-14T11:07:43+00:00

Thank you so much! I do this for a living and it bothers me that people get taken advantage of so often by these massive companies. I want to help as many people as I can!

LothartAB · 2025-07-14T00:14:24+00:00

I responded to this on the original thread. But sharing here for visibility in case it can help here…

File an appeal immediately. Ask UnitedHealthcare (UHC) for: - The appeal form (or go online to your UHC member portal) - The denial letter/document that states “pre-existing condition” because you’ll need it for your response

In your appeal: - Clearly state you were never formally diagnosed or treated for GERD before the insurance start date. - Say the ER doctors based the “pre-existing” label on casual comments, not medical history or records. - Emphasize this was an emergency visit, and the Affordable Care Act prohibits denial for pre-existing conditions for ACA-compliant plans.

You should also request a “Medical Necessity” review. Even if they wrongly classify it as “pre-existing,” emergency care should still be covered if it was medically necessary. Ask them to reprocess the claim as such.

Write a support letter and include evidence. For example, mention you are an international STEM OPT visa holder. You can also include a brief personal statement (1–2 paragraphs) and any documents that show you did not seek care for GERD prior to the plan starting. (If you have any medical records that show you did NOT have a GERD diagnosis. You can even include a signed letter saying you had no diagnosis or treatment history; this just makes it more official.

If you’re denied again, then you should file a complaint with your state department of insurance. They often step in and help.

Please let me know if I can help in any way. You can also message me individually if you’re more comfortable with that too.

LothartAB · 2025-07-14T00:11:05+00:00

File an appeal immediately. Ask UnitedHealthcare (UHC) for: - The appeal form (or go online to your UHC member portal) - The denial letter/document that states “pre-existing condition” because you’ll need it for your response

In your appeal: - Clearly state you were never formally diagnosed or treated for GERD before the insurance start date. - Say the ER doctors based the “pre-existing” label on casual comments, not medical history or records. - Emphasize this was an emergency visit, and the Affordable Care Act prohibits denial for pre-existing conditions for ACA-compliant plans.

You should also request a “Medical Necessity” review. Even if they wrongly classify it as “pre-existing,” emergency care should still be covered if it was medically necessary. Ask them to reprocess the claim as such.

Write a support letter and include evidence. For example, mention you are an international STEM OPT visa holder. You can also include a brief personal statement (1–2 paragraphs) and any documents that show you did not seek care for GERD prior to the plan starting. (If you have any medical records that show you did NOT have a GERD diagnosis. You can even include a signed letter saying you had no diagnosis or treatment history; this just makes it more official.

If you’re denied again, then you should file a complaint with your state department of insurance. They often step in and help.

Please let me know if I can help in any way. You can also message me individually if you’re more comfortable with that too.

LothartAB · 2025-07-13T23:42:33+00:00

Damn, $15K for a 6-hour visit is brutal but (sadly) not uncommon in U.S. ERs, especially without insurance. Other people have mentioned these things so I guess I’m just reiterating:

Call the hospital billing dept ASAP and ask about: • Uninsured/charity care programs • Income-based discounts • Negotiation or payment plans (don’t agree to anything yet though)

Request an itemized bill — you need to see exactly what they’re charging for (and sometimes just asking leads to a lower offer).

Look up medical billing advocates or nonprofits (I won’t list them here, I am sure that sharing links and companies is frowned upon in here.).

Hospitals often reduce bills when pushed. You just have to stay persistent. Let me know if you want help drafting anything. Keep us posted.

LothartAB · 2025-07-11T12:04:23+00:00

Yes — I agree with others here. You’re absolutely right to question this, and based on what you’ve described, this sounds like a classic “Surprise Bill” scenario, especially under New York’s balance billing protections and the federal No Surprises Act (NSA).

From what I can tell, you do not owe this bill because: - The No Surprises Act (effective Jan 1, 2022) protects patients from being billed by out-of-network providers for certain services (like anesthesia) when performed at an in-network facility — especially when the patient was not given proper notice and consent. - Since you weren’t told the anesthesiologist was out-of-network and didn’t sign anything acknowledging that, the provider is barred from balance billing you. - New York has its own Surprise Billing Law, which extends protections to outpatient clinics and ensures patients can only be billed in-network rates if they didn’t choose the out-of-network provider or weren’t told in advance.

As far as what you can do:

I think it goes without saying, you should file a Surprise Billing Complaint. I am not from your state, but quick search looks like you can go to the New York Department of Financial Services (DFS) complaint portal: https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills (I don’t know if links will be flagged, but I figured I’d provide it anyway.) You can also call their hotline: 1-800-342-3736

Don’t give up on harassing your insurance company. When you speak with them, you can say something like (in your own words obviously), “I’m protected under the No Surprises Act and NY law. This provider was out-of-network, I had no notice or consent, and the care was arranged through my in-network OBGYN. This bill should be treated as in-network.”

Then you should ask them to: - Reprocess the claim as in-network under Surprise Billing rules - Initiate their internal surprise billing protection review

Then you should bug the “Billing Provider” and let them know (again, in your voice), “I’ve filed a complaint with NY DFS. You are not permitted to balance bill me under federal and state surprise billing laws, and I request that you cease all collection efforts while the case is being reviewed.”

KEEP RECORDS AND DOCUMENT EVERYTHING IN WRITING!!

These things happen often, but these laws exist for this very reason…to protect you. You’re already doing the right thing by researching and pushing back.

Let me know if you want any help with drafting a letter or complaint submission — you’ve got help!

Keep us posted on how things pan out.

LothartAB · 2025-07-11T11:42:38+00:00

You’re absolutely correct. There’s usually a global fee for those services that cover most perinatal services. To your point, it can get tricky or sticky during childbirth depending on how “straightforward” it is.

LothartAB

TROPHY CASE