The Power Transformation Podcast

107. Empowering Patients Through Healthcare Advocacy & Insurance Expertise with Adria Gross

• Alethea Felton • Season 2 • Episode 107

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What does it take to navigate the tangled web of the American healthcare system and come out stronger on the other side? Join me as Adria Gross shares her powerful journey of resilience, from overcoming encephalitis and epilepsy to becoming a fearless advocate for those battling the challenges of medical claims. With compassion, determination, and an unrelenting drive to bring clarity to chaos, Adria transforms the daunting world of healthcare into a mission of hope and empowerment. Her story will leave you inspired to tackle your own challenges with courage and purpose.

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Episode 107's Affirmation:
I have the right to speak up for myself because my voice matters. 

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Alethea Felton:

Hey, hey, hey y'all, Welcome back to another episode of the Power Transformation Podcast. I am your host, alethea Felton. Thank you for joining me today, and I am so excited because season three is approaching very soon. Season three will kick off in December and I have lots coming down the road for 2025. Just not with the podcast, but with everything happening in my life, in my business, in just a lot, and also I'm going to put it out there. You all, I am also a professional speaker, so I am open for speaking engagements. A lot of that is happening as well, so I will be making some announcements regarding that coming up very soon in terms of a speaking engagement that I have coming actually in December. It's a virtual engagement, so I'm excited about that, but I'll talk about that later.

Alethea Felton:

I've got to simply say that the guest today, adria Gross, is a phenomenal human being. Yes, that transition I had to make because when I'm talking about speaking engagements and things of that nature, yes, that transition I had to make because when I'm talking about speaking engagements and things of that nature, adria has such a gift of helping people find their voice when it comes to this world of insurance and claims and things of that nature. If you have ever had challenges getting claims approved or have had issues with the healthcare system, she is the advocate of all advocates in knowing how to navigate through those challenges with healthcare companies. She is well known in the industry and I am so honored to know her. She is a wealth of knowledge for people at all levels of healthcare insurance, regardless of your generation, regardless of the type of plan you have. She knows how to navigate the system and these companies know her. So she is the guest for today and I want to jump right into this episode Because of the topic of it.

Alethea Felton:

Share this episode with at least four people that you know. Share it with at least four people. More are always welcome to hear it. So, yes, share it, and I want to jump right into this interview. So I'm going to start with our affirmation. I'm going to say it once, and then you repeat it, and then we're going to have a powerful conversation with Adria Gross. I have the right to speak up for myself because my voice matters. I am so thrilled to have Adria Gross today as our guest and, as you heard from the introduction, she is a wealth of knowledge and so much more Just, classy, elegant, knowledgeable, everything. And Adria, I'm so happy to have you here on the Power Transformation podcast.

Adria Gross:

I'm thrilled to be with you, thank you.

Alethea Felton:

Of course. Now let's go ahead and just break the ice, some for our audience and for me. And I like to ask this question, just so we get to know you better. But, adria, thinking about who you are, what is one of your favorite hobbies?

Adria Gross:

I, you know, I never thought I'd ever write a book and, and I have to tell you, when the suggestion came to me from my coach, who also does my website and marketing and advertising, he said, okay, you got to get a book out and and his suggestion was to educate people on the company I've been running now. I started a business 19 years ago and then I added a division about 15 years ago, but I've been in the health insurance industry now for 35 years and I don't want to give up on writing the books. I love what I'm doing. I always wanted to be a teacher and I know that my books are educating people, so I never thought I would do this, but I'm so happy that I'm on track Really happy, thanks.

Alethea Felton:

Wow. So it seems like it's almost a hobby that came over the years, where it's something you did and you knew that, wow, I really like this and I'm helping people and I want to continue doing it. So I like how that type of a hobby came to you and I think it already shows people from the start that you may have hobbies that you haven't even discovered yet until you try, and I think it's really transformative. And it leads me into asking Adria if you were to describe Adria Gross, who would you say is Adria Gross?

Adria Gross:

I'm telling you I have had an amazing life. I mean, when I look back at everything that I went through, you know I got sick when I was 11 and a half. I had encephalitis was an inflammation of the brain, and I was in school at the time and the teacher thought I was trying to get an exam. I just wasn't feeling well and my friend walks me down the hall, sat down in a chair, went into a coma and my dad came to pick me up a couple hours later and he saw I could walk but I couldn't talk, came to pick me up a couple hours later and he saw I could walk but I couldn't talk. And and I was. I wound up coming out of the coma after 10 hours and I realized after being sick I had encephalized inflammation of the brain. I was amazed that I lived with epilepsy. I received epilepsy from that and I lived with epilepsy for almost 25 years. I used to average 18 seizures a month. At one point I was on 32 pills a day, never controlled, but it was just a very tough life.

Adria Gross:

So after I had a left temple abectomy, they took out a portion of my brain. I even said to the doctor afterwards. I said show me what you. He was a neurosurgeon. He had a brain on his desk and I said show me what you took out. And I turned to him and I said that's the size of a cook knock worst. But you know what? I lived with this condition and my first job, I mean I went to school for education. They wouldn't certify me to be a teacher because I walked out of a classroom was before the disabilities act of 1990 and um, and I always wanted to be a teacher, so couldn't. Worked in the garment industry. After the brain surgery, my first job I went to an insurance company in the claims area and within two weeks they taught me how to deny claims.

Alethea Felton:

Wow. So I'm going to pause you there and we're going to definitely talk about this more. But it's so ironic how you talk about having had this passion of wanting to be a teacher and, as you know, I'm an early retired educator who worked in schools for 20 years in multiple roles just not inside of the classroom. And the reason I say it's ironic is because American schools in the states are bleeding for teachers. They need teachers now and pretty much anybody can literally get a job as a teacher now.

Alethea Felton:

And to know that you actually had the heart for it and were denied it, but yet you found a way to educate people in a different way. But I want to talk about this really quickly, about your journey, because what you do now, I think, is so powerful and we'll talk more about that. But although you touched on it, take us back to that early diagnosis of encephalitis. You said, of course it's inflammation of the brain, but what were some of the symptoms of it? And then how do you grapple with all that? Being a child living with such a condition? That can be fatal.

Adria Gross:

Well, it was really hard and you know where I was living in the time. It was Port Jervis, new York. I wound up in New York City and I'm on a floor where everybody was under the like 18 or younger. You know it was like the children's floor at New York University Hospital and my mother comes into the room. First they thought it was a brain tumor, which I'm lucky because I didn't. You know, I didn't. People die from that, people even die from encephalitis and I was really blessed that I'm still alive. I mean, it was like unbelievable. But my mom went down the hall and she was walking into rooms for other children just to say hello. And she comes back to me and she says I want you to come down the hall with me, I want you to meet somebody. And the woman at the time she was about 16 or 17 years old and she had open heart surgery. And after we left her room and I'm only 11 and a half years old my mom said to me there's always someone who has it worse than you. And what happened to me?

Adria Gross:

This last book I got out, my first book, was solved Curing your Medical Insurance Problems. Ralph Nader liked it so much he won an international edition. Multi-payer medicine nightmare made in the USA. But this last book, apparently different. Really, in the first chapter of the book it talks about friends of mine. Like the woman who walked me down the hall, her parents said to her don't be friends with Adrienne anymore.

Adria Gross:

So I mean, here at the age of 11 and a half, people who I'm friends with are avoiding me. That's why I did apparently different. I was apparently different and people avoided me and I saw the change after having the seizures for 25 years of my life. And now nothing was stopping me. I wasn't having seizures stopping me. I wasn't having seizures. And I remember my brother and a friend of mine said to me your intellect has changed. So I was blessed. I was blessed very much because I had nothing stopping my life by having a seizure. A lot of times it took me four hours to come out of a seizure. You know, like the seizure might last only for maybe a few minutes and one time I I had one after the other, where one was an hour, the next was another hour. But the thing is, you know, when you have a seizure it exhausts you and you've got your.

Alethea Felton:

Your brain has to rejuvenate, yeah, and really, really quickly in terms of a seizure, because my sister also lives well, lives with epilepsy, but she gets blackout seizures. Were your seizures like grand mal seizures they change.

Adria Gross:

They change with medication. I got to tell you something. Chapter three of my new book, apparently different, is. I tried to make it funny, you know, but seizures change with medication. That's what happened to me Interesting. Yes, when you would change to a different medication you might get a different type of seizure. So I had in the book apparently different. Chapter three is for psychomotor seizures and the crazy things that I did Like I had a date I meet him in in the village and in Greenwich village.

Adria Gross:

And you know you'd get nervous when you're meeting someone right? And here I'm meeting him for the first time. I went into a psychomotor seizure and I ran away from him. Oh, ran three blocks. I come out of the seizure. I said what just happened?

Alethea Felton:

oh my goodness you know, totally blanked out of it. I mean yeah, yeah, oh yeah yeah, you know.

Adria Gross:

so I mean, when I read that chapter I mean it's in a way it could be funny, but it could be a little of my cry over. That might be sad, it wasn't at the time.

Adria Gross:

Yeah, yeah, yeah I mean you can look at it both ways, but it was. I mean, I lived through rejection. I lived through rejection when I met this guy. After I, I finally realized, oh my God, I had a psychomotor seizure. I went and ran away from him. And then I finally said, oh my God, I had a psychomotor seizure. I went and ran away from him. And then I finally said, oh my god, I had a seizure and I told him what happened and guess what he did? He turned around and walked away from me. Wow, so you know, I, I my heart goes out to people who have, who have seizures because, or even other things, because look at, look at what he did to me. He just walked away.

Adria Gross:

You don't want to hear anything and I'm sure, like in the book, it's not just about me, it's 25 other people. But what I'm trying to teach people is not to be scared of others who have a condition. Treat them as human beings, treat them how you want to be treated. That's what you have to think about, like what if they were in your position? What if they were sick? Yeah, how would they feel if I just walked away from them?

Alethea Felton:

That's right. That's right, and thank you for bringing an awareness to that, because, although you know I live with certain conditions, it doesn't matter, just as you said, what we have, but it's that universal connection that we have with it and I'll never forget and I don't think I've ever shared this publicly but I was dating a man years ago when I was in my 20s, and he was just not someone I was dating, but he was an actual friend, I mean a friend, and when I started getting sick with the Crohn's and things of that nature, we had been friends for several years and we're dating. I mean, yeah, dating, but he just abruptly cut me off and had some type of lame excuse. So it hurt, to say the least, because I didn't understand why, and especially the last thing he said to me. After we talked about everything, he said I promise you that I'm not going anywhere, and it felt so comforting. And then that next day he totally ghosted me.

Alethea Felton:

So years later I saw one of his sisters at a mutual friend's wedding and she talked to me and said that he told her the reason why he left was because it scared him. So he's married now, great and all. But I honestly said, adria, when I found out he had gotten married, I literally said I pray to God that his wife never gets sick, because if you can do that, then now of course all is healed and well, I have a wonderful man now who embraces me. But I think that you saying how your date at the time just walked away, that can truly leave a scar in the moment that can take years to heal. And it leads me to asking you is that from your epilepsy, the brain surgery, all of that? How did societal attitudes towards you change or shift after your surgery? And how did that shifting affect even your understanding of empathy and compassion?

Adria Gross:

Yeah, I got to tell you all of a sudden I could be friends with anybody anybody you know and why is it that people couldn't treat me that way before? In this book that came out there's a woman who I spent a lot of time with and she was the one who walked me down the hall. She became a nurse. Her husband is a neurologist. It's amazing. She walked me down the hall. Her parents turned her and said don't hang out with Adrienne anymore, she's not well. She apologized to me when the book came out, because I interviewed I've interviewed a lot of people who knew me even before I got sick, and you know it was.

Adria Gross:

It was interesting to see how they felt about it and I interviewed them because, look, I want people to read this book apparently different, but inside there it talks about how these people felt when I got sick and it opens minds of others who are not well and look, my prayers go out to all of them that, please, god, may someday there be a cure for your condition and be helped. But listen, people are scared, they don't know what to do and they don't know where to turn. And my next books could be apparently different for kids, because I want kids to learn early that they should not be this way. They really have to be open and willing to learn and not close off other people because, hey, you're different, you're weird, you know what's wrong with you, like no, you know. Everybody should be treated equal.

Adria Gross:

And again, if it happens to them that they get sick and someone walks away from them, how are they going to feel about it? And they need to start thinking about this. Adults, children there has to be a change in how others treat you. Because you have the condition. I mean I couldn't believe that I was rejected and then, after the brain surgery, those problems didn't exist anymore. You know, I mean I'm happy that I'm well, I'm happy that I got over my condition, but I just can't believe that people will treat you that way because of their own fears and insecurities. That's right.

Alethea Felton:

Yeah, that's right. And so, in terms of you being an advocate even now when it comes to the insurance and medical fields, what led you to even doing that, adria, and, in that line of work, tell us a bit about what you do there, as well as what have been some of the most significant challenges that you've encountered in that role, and how has that shaped your own personal approach to advocacy?

Adria Gross:

okay, um, you want to know the challenges and what yeah, so yeah, yeah yeah, I'll tell you what happened.

Adria Gross:

Yeah, after after um, I had the brain surgery, I had two years at one insurance companies where within two weeks they taught me how to deny claims. And then I went to another insurance company I I did training. They were moving down to to Richmond, virginia, from New York my division and I did training down there and then I went to another company which I worked at for 10 years and I had three different positions there. My first position was again denying claims. So what I learned at that company is when I did denials and all of a sudden you get a phone call and they say, adrian, pay this claim, I learned how to twist the arms of the insurance company to pay the claims.

Adria Gross:

Wow, if you match within the requirements of what your policy says, I'm going to overturn that case. I'm going to get it done. I'm going to get it done. I don't mess around. I mean, I've been my God. I was just recently in the New York Magazine, and that only happened a few weeks ago, and in February this year I made the front page of a newspaper of a case that was $225,000. That's amazing.

Adria Gross:

And she had been. I couldn't get it paid and finally, when it made the media, they called me up. Within two days, within a couple of days before it was going to be published, they called me up and they begged me not to publish it. And then I said look, you guys waited four and a half years before you finally told me that you're going to write off the bill. But look what I had to do to get you to write the bill off. Yeah, exactly.

Adria Gross:

And three times I said please, please, don't report it, don't report it. And I said, look, I'll talk to the writer, but I can't guarantee I'm going to get out of this. I said you need to understand this. And I called the writer and they still published the article. So you know, the thing is this. That's a challenge in itself and I you know what it's so rewarding to me. It's nothing about the money. When someone calls me up, I always tell them hey, this is what you could do. If they want to hire me, I'm here to help you, you know.

Adria Gross:

But those, those really are, when you think about it, those challenges that people face. I mean, I lecture before attorneys, cpas and financial planners to teach them what they need, to tell their own patients, what they can do to help their patients, which is in the book you know solve, cure your medical insurance problems. The first time that I even thought I could do anything like this a gentleman who helped me start my billing business, who I saw through SCORE. He had a bill for $108,000. And when you took away what was related, definitely okay, we'll pay for those what's not related and what's questionable. When we took those questionable, not related away, his bill went from 108,000 down to 22. He won the case. They only had to pay back $22,000. So I mean what I realize that I can do and I'm so grateful every day to be healthy and to help all these people. I mean the whole thing is a blessing in itself.

Alethea Felton:

Yeah, exactly, and so was it from your own personal health challenges that even led you to do this line of work. Or was that not your initial way of thinking at first, but it kind of formed into that.

Adria Gross:

So I had brain surgery in March of 89 and I started working for an insurance company in September I'm sorry, december of 89. Ok, ok, so I go back to the neurosurgeon. Ok, and the bill was sent. I was insured immediately through my employer. Ok, well, I get the bill in the mail for was insured immediately through my employer.

Adria Gross:

Okay, well, I get the bill in the mail for $275, and I say I'm an employee here, I'm working for an insurance company, I'm working for you. Can't you pay my bill, my entire bill? They said, well, we'll look at it again. So what they did, $275 I had to pay. They reduced it down to another $17 less. Oh my God, and I'm an employee. Exactly, you're charging me. I could have paid that Right.

Adria Gross:

So I have to tell you that was my first taste of what it feels like when you go into a hospital. You might have surgery like that one, I told you, but 225. I've had claims over a million dollars. I had a case where this woman, you know, she got insurance through the state and then the hospital decided they weren't going to take people anymore. She had stage four cancer for three years. She had stage four cancer for three years. Now it's her fourth year and they say to her hey, we're not going to pay that hospital any longer. Let me tell you, between the hospital and the insurance company, I did not give up. When I get a case, I put my teeth into it. I'll fight as hard as I can. The sad thing is that when they decided to pay out the one point something million dollars to the hospital, she died three weeks before that. Oh my goodness. Yes, the stories I could tell you are insane. But I tell people, don't give up. You have to fight for your rights. This is it.

Alethea Felton:

Wow, adria, and I want everybody, and so even you, to have the courage to write. Apparently different is a story in and of itself, and so you share deeply personal experiences in that book. But what was the most challenging part of writing that story and what do you want readers to take away from it?

Adria Gross:

All right, Listen, no matter what, don't give up. But I got to share one thing.

Alethea Felton:

Yes, go ahead.

Adria Gross:

I kept everything as a secret after I had the brain surgery. I didn't want to tell anybody anything. I didn't want them to know about me.

Alethea Felton:

What was your rationale behind it?

Adria Gross:

Fear that nobody would hire me.

Adria Gross:

Oh, I see, and then, when I realized what I was able to accomplish within about 10 years after the brain surgery 10 to 15 years finally a friend of mine pushed me to go open. Pushed me to go open. When I went open, when I finally released what I lived through and was able to talk about it, oh my God, the weight, the feeling in my head was relieved, you know, because now I can talk about it, and when you can get yourself to the point of not being scared to talk about your own situation, it helps you overcome it. But it will also help other people to learn what you experience and it will give them hope. Please hope that, hopefully for them there will be a cure at some point. Yeah, Wow.

Alethea Felton:

And so in your health and wellness journey I know that you you said how this had been a 25 year journey for you and that, thankfully, you are healthy now. But in what ways? In living through this, overcoming it, how has this even influenced your personal views on health and wellness? And what would you even say to a person who is trying to manage chronic health conditions while also going back and forth with insurance companies?

Adria Gross:

Well, look, you got to work hard, you got to pray and you got to try so hard to take care of oneself, you know, and to try and have a positive attitude. Not pity me, pity me, you got to, you know. I'll tell you in my book. I wrote it. My friend Robin is in the book and Robin when she was born, as well as someone who endorsed the book they both, both of these people, male, female they were both premature babies and they were both were both premature babies and they were both became blind due to oxygen. The oxygen burnt their eyes. They were an incubator and both of them, both of these people blind, had never seen a thing in their life. And you know what? They've both been successful. They've lived a great life. They would not let this hold them back.

Adria Gross:

Even when I had to decide whether or not I wanted brain surgery, I thought to myself, okay, do you want to have a disability the rest of your life or do you want to really try to be well? And I thought to myself, okay, I fell down, I broke a rib. I mean, I even fell on subway tracks in New York city. So when you think, when you think, hey, if surgery is going to help me. I said I'm done with disability. I was on disability for 14 months. I'm done with it. I'm not I'm. I really want to improve myself. I had the brain surgery and look at the outcomes.

Alethea Felton:

That's right.

Adria Gross:

So you always have to think positive and you always have to push, push, push yourself and don't ever give up. And we never know what's around the corner. There might be surgery for these conditions, that someday you might not have this problem anymore. There might be medications are coming out with that you might not have this condition.

Alethea Felton:

You know, yeah, yeah, and I like that. You said that because even with me, having lived with chronic illness ever since birth, oh my goodness, over the years certain people who have meant well have asked me, especially when I was a public school educator, I might have to go on short-term disability, maybe two and three month stints, but it was never over three months. But I'll never forget that I had certain people, this one person in particular. She always asked me why didn't I just go out on permanent disability? And I'd say because I can still talk, I can still walkplegics and are still doing amazing things. I still enjoy making a difference in life and pursuing dreams. So I don't have to be, you know, a total invalid if I don't have to. And so thank you for even saying that. But I find sometimes I can't speak, of course, for everybody. But I find sometimes I can't speak, of course, for everybody.

Alethea Felton:

But even in terms of trying to get new clientele in coaching people with chronic illness, that can be hard to do, because sometimes some people are so used to being sick that the thought of being well, or at least changing your perspective on it, is challenging and difficult, or at least changing your perspective on it is challenging and difficult, and it's something that they have a hope for but are scared to actually try and do, and so that's why now I'm shifting more towards more speaking engagements and things of that nature, and so it causes me to ask you this in thinking about what you do in in representing clients and advocating for them, let's talk about what it's been like going to the table, letting it be known to these insurance companies.

Alethea Felton:

Hey, this is what I do. I have a track record of success. What has been some of the challenges in even doing this line of work, and how have you been able to, over the years, earn trust and respect and understanding from these big wig companies? Because you have a gift, adria, and you are known. People know you in that world, and so they know if they're going to approach you, they have to come correctly. So how do you do that? What is your superpower in that?

Adria Gross:

Let me tell you, I never. I always, at the beginning, I was so scared to speak to people. But, yeah, and I couldn't even lecture. I was taking classes to even be able to speak before people. I was in an organization called Toastmasters. Oh yes, but first of all, I tell people never give up, never give up, never give up. And then, as I kept on working harder and harder to go out and speak and educate it, I became much more confident within myself.

Adria Gross:

Ok, and and you know, even look, people are scared. I mean, hey, when I went on disability, it took me six months to decide whether or not I wanted to give it a try and have the brain surgery. I saw a therapist at the time and I said to myself do I really want to? Look? I never thought I would ever be published. I never thought that I'd be able to fight and speak to these hierarchies. I mean, I never thought that I would be published.

Adria Gross:

Like, I have different reasons why with each case, right. Well, you know what, since I really understand the ins and outs and and, and I've had the courage to go up and talk to these people, right, I feel so confident within myself. But it takes a lot of work and trust within yourself. You know, and I always tell people, like I said before, don't ever give up, try your best to do it. If you, you know, if you need help, ask for help. Maybe have friends who can help you. You know I always have. You know I always try to help people, no matter what. But you have to have the courage and don't let them, don't let them tear you down that you feel incompetent. Don't ever let that happen. Just keep on building yourself up and believe in yourself.

Alethea Felton:

That's right.

Adria Gross:

You know and, and, and, please, please, hopefully you'll get strong enough that you're going to fight for your rights.

Alethea Felton:

And so how? How did you build yourself up? I know that you said you had a therapist and all, but, but how? How did you build yourself up? Say hypothetically and I'm not asking to be funny acting but say there's someone listening or watching and say I hear you, adria, I have a hope to be able to speak up more confidently or even have the courage to connect with you, but it seems like you did it so effortlessly, although we know that's not the case. So so how did you build that confidence? Was it that the rubber hit the road and you said look, I've had enough, I'm just going to go all out?

Adria Gross:

I guess you could say it that way. I mean, you know I I'm going to tell you. What really did me in to do the work I'm doing now is when I went to one of my colleges. I asked them. I said to them I have epilepsy. I said can I come to college here? Is epilepsy going to be an issue? And they said no. Well, let me tell you. I was teaching. I went to college in Cambridge, right next to Harvard Law. I taught in Arlington, massachusetts, and when I walked out of a classroom due to a seizure and then came back in after about 10 minutes, they called me in two weeks later and they said to me we recommend you leave the college and reapply in two years. And I said look.

Adria Gross:

I said that's what. That was my first clue that I could fight. And what I did is I said to him hey, look, you knew I had this problem and you allowed me to come to your college. And now I'm in my last year of college and you're telling me to leave and reapply to yours. I said no way, that's not going to happen. I said because you accepted me, I'm here, I'm almost done. I said okay, now I found out Nobody told me this that the state of New York and New Jersey it was before the Disabilities Act of 1990.

Adria Gross:

They never told me you know that, hey, you can't be a teacher. They never said that. They took my money and now you're saying come back and reapply. That's not going to happen. And I took graduate courses in counseling for MSW, masters of Social Work, which got me to graduate. Instead of that June, I graduated that August. But that in itself made me a fighter and that's what you have to do. Like I said earlier, you have to fight for your rights. Don't let these people just push you and push you and push you Like look, there are people who said to me you're going to be a failure. And when they said to me I'm going to be a failure. I'm still friends with them today and guess what? I proved them to be wrong. Wow, yeah, you know, fight, fight, fight, yeah, yeah, don't give up.

Alethea Felton:

Don't ever give up.

Alethea Felton:

That's right, and I want everybody listening or watching this to know that I so resonate with that, and I'm glad that you said it.

Alethea Felton:

Regardless of your age, regardless of anything, you've got to fight, and that's the one thing I've had to learn over the years.

Alethea Felton:

Just not with health, but with anything that you desire.

Alethea Felton:

You have to push yourself to do it, because, at the end of the day, these same people that close doors in your face or tell you you can't the way I always view it, adria, is when they wake up in the morning, they have to shower, brush their teeth, go to the bathroom, just like I do and, at the very end of the day, we're all born into this world the same way, even if we might come from different socioeconomic statuses.

Alethea Felton:

I mean that we're all born as babies and we have the opportunity to create the life that we desire for ourselves, if we believe it enough. So I thank you for being that light, almost in a sense, being a trailblazer, because the reality is there aren't a lot of people doing this work. There are some, but there really aren't a lot doing this work. And so, with that being said, reflecting on your overall journey, reflecting on your overall journey. How has hope H-O-P-E, how has hope played a role in your ability to persevere through adversity, and how can our listeners and viewers cultivate hope even in their lives to continue to keep fighting and going on?

Adria Gross:

Listen, you just have to believe in yourself. You have to believe that you can do it. And as long as you believe it and you have that positive attitude, look, I tell people, you know, when they send me their bills, I say to them you can't, we're not going to give up, like even that case that made the front page and I fought for four and a half years for her. I said to her all along don't give up. She wrote to me today and she says you know, aja, I had dreams, I had nightmares that this was never going to happen. She says you fought for me and you didn't give up. And that's what everybody has to do If someone puts you down, or they, you know, or they say you know you're going to be a failure, or you know you want to give up, you can't handle it anymore. I'm telling you do not give up, do not, you know, believe in yourself.

Alethea Felton:

And as long as you keep on pushing and pushing and pushing, you're going to be fine. Yeah, and you've shared a couple of examples, but tell us an example of a client with whom you've worked that stands out the most to you on how you really helped that client get what they were deserving of and how you're helping them change their life. What's the case that like stands out to you?

Adria Gross:

Well, I had one case where it's a certain surgery they use for epilepsy and it was after I had my brain surgery. I can't think of the name of it, but they put something in your neck and I don't know exactly how the mechanism it. But they put something in your neck and I don't know exactly how the mechanism works, but it will stop seizures, okay. So here's a woman major depression, major to the point that she tried to commit suicide. Okay, and it was insured through a major health insurance company. What happened was she did not have epilepsy and they did the surgery for her for depression. And she read all these cases where it would help depression. So she contacts me and I said to her let's see what I can do to help you.

Adria Gross:

Okay, so I went to the insurance company. I spoke to the executive office and I said to him look, nothing is working. She's been through all these procedures, medication, everything. It got to the point that she's so depressed that she tried to commit suicide. I said to them I think what really turned the switch is when I said suicide, even though she didn't have epilepsy, but she had major depression I got them to pay the claim and when she went to the hospital for the surgery, they turned to her and they said to her we have never had a case before where they're going to pay for this surgery, even though you don't have epilepsy. And they did the surgery and now she no longer has. It's helped her. This mechanism that's put in the neck has helped her to you know, for for the depression.

Alethea Felton:

That's fascinating.

Adria Gross:

Yeah. So that's why I say to you you know, I mean look, even even when you get a denial and we do research on it and we see that this is helping people, um, well, we can prove that a lot of times I might be able to get that case overturned and and and, of course, look if look, but there's no guarantee that surgery is ever going to work. That's right, yeah, but hopefully it will, and in her case it did.

Alethea Felton:

Wow, that is quite powerful, and I'm glad to hear she is doing much better. And so that brings me to this next question and, although we've been talking about it, just for further clarity for the audience, two things who exactly do you help? So someone who's listening saying you know what I might need to contact her about something. So speak directly on who should contact you. And also how can a person connect with you? Do you only work with people that live in certain states? Tell us about that, how they can contact you, who you help, et cetera.

Adria Gross:

I am a national company. I'm honored I'm so honored to be able to do what I do. And what I look at is this If your claims are denied, out of network, overcharged, you can't get pre-authorization. Come to me, I'll give you the best guidance that I can, and you know I only have a limited time to talk, but if you want to hire me, I'm always here, but I also.

Adria Gross:

This is a crazy thing that's happening now. When you turn 65 and you're going on to, you're going on to Medicare and you see all these commercials are starting already, because you usually have to make a decision by the beginning of December what you're going to do for the following year. So what's happening is, if you decide or let's say, look your employer when you retire, a lot of times they put you on these Medicare Advantage plans. If you go on a Medicare Advantage plan and they're throwing you out of the rehab, right now AI artificial intelligence is throwing you out within three days. Otherwise it's usually two to four weeks. And if you're improving when you're in this rehab, you're going to call me up.

Adria Gross:

A lot of attorneys send me cases like this because they don't know what to do. But with all my years of experience in the insurance industry. I get the information together that we need and I go before the Medicare judges. So if your claims are denied out of network overcharge, you can't get pre-authorization, or you got a Medicare Advantage plan where they're throwing you out of a rehab, or if you've had a long-term care policy for years and you meet the requirements, you wind up in a long-term care facility. You have the insurance and you meet the requirements and they're denying you, come to me. I overturn those cases in any of those and the name of my company is MedWise Insurance Advocacy. My website is wwwmedicalinsuranceadvocacycom. Again, that's wwwmedicalinsuranceadvocacycom and you can just call me at any time. I even do answer phones, unless I'm really busy on the weekends. I do answer phones and my phone number is 845-978-9493. Again, it's 845-978-9493. Please call me at any time. I'm here to help you.

Alethea Felton:

Thank you, Adria, and I will definitely put your website in the show notes and everything like that, and I absolutely love the work you do. That's why, when I first met you, I said there's no doubt not just to have you as a guest, but to just keep in touch with you in general, because you're so knowledgeable and I'm so passionate about this type of work that you do and advocacy. It's so important. And so my closing question for you oh no, this is important. How can people buy your book? Tell us, how can they buy books? I've got three books that are out.

Adria Gross:

If you want to read about fighting the insurance companies, and one I recommend is Solved S-O-L-V-E-D explanation point curing C-U-R-I-N-G. Solve cure in your medical insurance problems. If you really want to take a look and look within yourself with your own issues that you have read Apparently Different the cases in there, some of them as sick as you may be, you're going to see other people in there who have it much worse than you. So you know either of those books I'd recommend Solved is really going to help you with your insurance issues and apparently different Should make your life a little bit easier to say, hey, I don't have it that bad, you know, and it's. And that book is all about respect for people who have a condition.

Alethea Felton:

And they're on Amazon. Can we buy them through your website? What?

Adria Gross:

You can go to my website. It's on there. I have wwwmedicalinsuranceadvocacycom. I also have wwwadriagrosscom. Or just go right onto Amazon. The three books are there. Just type in my name Adria Gross book, amazon. It'll take you right to the three books and, again, audience.

Alethea Felton:

I will have all of these in the show notes or, if you're watching on YouTube, in the description and Adria is so humble, but she's a big deal and she's not going to act like she is. So that's up to us to say she is, but she's a big deal and she's really doing incredible work. And so, as we come to a close, adria, my closing question for you is how has this advocacy and line of work and service that you do transform your life?

Adria Gross:

Oh boy, I have to tell you and I always say this to people I love helping others and if you go out, even if you have a condition, but you're able to help others, do it, because not only are you helping them, you're going to help yourself. It helps you to think and, like I said, there's always people who have it worse than us and it's going to make it easier for you to live with your condition, but hopefully someday it will be cured. Thank you.

Alethea Felton:

Thank you, adria. It was such an honor having you here on the Power Transformation podcast. I continue to hope and pray the best for you in this work and thank you for just gracing us with your presence today. Thank you, if you enjoyed today's show, then you don't want to miss an episode, so follow the Power Transformation podcast on Apple Podcasts, spotify or wherever you usually listen, and remember to rate and review. I also invite you to connect with me on social media at Alethea Felton, that's at A-L-E-T-H-E-A-F-E-L-T-O-N. Until next time, remember to be good to yourself and to others.

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