Health Insurance Bills Tips

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Read Each Section on The Bill for Interpretation

A medical bill from a physician or a hospital admission looks different from a credit card or any other bill you may receive. The information contained on the physician and hospital bills is universal among similar type providers. The key fields tell you about your visit and what has happened since: Sender: A number of physicians and hospitals employ an outside medical billing company to bill and collect for the services they provide to patients; Statement date and payment due dates; Patient: This is sometimes different from who the statement is addressed to; Description of Services: The listed procedures and services the patient received on date of service; Explanation: Explains the reason the claim was not paid or was paid; and, The Amount Due: This is the difference between the charged amount, non-allowed amount negotiated by the health insurance carrier to pay for these services, amount paid by the insurance carrier and payments made by you. If you go to a participating provider the amount due from you should not include the non-allowed amount.

   

Incorrect Room Charges

If you were in a semi-private room, make sure you're not being charged for a private room. Were you charges for the box of Kleenex and slippers you brought from home? Did you skip a meal and were charged for it? In order to avoid this, be sure the nurse or clinical staff documents these things is your medical records before you get your bill so you can go back to them if you need to show additional proof.

   

Duplicate Billing

Make sure you haven't been charged twice for the same service, supplies, or medications.

   

Hire An Expert To Help

Never assume that your insurance company received you correspondence, or is going to pay the remainder of the balance. If you are having trouble dealing with the paperwork, or getting payment from you insurance company, you can get help from a local claims assistant professional.
One such organization is the nonprofit Patient Advocate Foundation, www.patientadvocate.org/ which is a national non-profit organization that seeks to can provide assistance through this frustrating process. Some of these types of foundations also help resolve financial problems precipitated by illness. Generally, the services are free, but you need to have a chronic or life-threatening illness to qualify. Some other alternatives include Healthcare Navigation firms that can charge from $50 to $250 an hour depending on the help you may need. To find specialist in your area, you can go to www.billadvocates.com or www.claims.org. Some patients may prefer an advocate who specializes in a particular area of medicine.
Although finding a healthcare navigation firm that specializes in a particular area of medicine sounds preferable, be aware that advocates with a medical specialty may not provide much help with insurance paperwork.
Since it can be difficult to find errors in your medical bill, the next 10 tips are things you should be looking for specifically. Some hospitals have patient advocates that help the patient get through the billing process. You may also be able to go over some of these items with your doctor during your follow up visit. Just be sure you notify his/her staff when you are scheduling the appointment.

   

Look For Billing Mistakes

About 80% of all hospital bills contain errors. This can increase your tab by about 25%. This is why it is extremely important to keep a log of every test and medication you get, and check it against your medical file, which you can order from the hospital's billing office. If you find an error, send a certified letter requesting a corrected bill, and a copy of all documentation to your insurer. Explain the errors you have found and DO NOT let the hospital/medical facility tell you that your insurance will take care of it. Be sure to get all information including how the hospital plans to take care of it and by when in writing as well as the person you spoke to and their contact information so you can follow up on it and keep copies of everything. If things are unresolved by the date promised, sent your complaint in writing with copies of all documents and correspondences to the Office of Consumer Affairs at your state's Attorney General's Office.

   

Do Not Ignore Your Bill

As soon as a clinician interacts with you, the billing process begins. However, depending on your health care insurance, income status, bills, and resources, your final bill may be negotiable. You first need to take the correct steps.
Keep in mind that if your case involves a car accident or a workers compensation issue, then by law the person that hit you or your place of business where the accident occurred the “workers comp” incident, will get billed first. This means you have an extended period of time to figure out how you are going to pay your bill. More and more medical facilities have hired collection attorneys on a contingency basis to file judgments against people that do not pay their bills. This will go on your credit history.
Typically, you will receive at least three statements from the facility before any action is taken against you. In some situations, the medical facilities will file a judgment against you, so if you have acquired any assets you will not be able to liquidate them until all outstanding medical bills are paid. On the other hand, some medical facilities that do not have the means to hire a collections attorney will write off any unpaid bills as “bad debt” if no action has taken place in six months.

   

Arrange For A Payment Plan

Especially for more expensive procedures, but be sure the hospital does not charge you a large amount of interest. If that is the case, you might as well pay for the procedure on your credit card and gain frequent flyer miles in the process! Inquire about paying a larger amount in cash upfront and the hospital may opt to give you a steeper discount. Just remember, what ever you agree to, get it in writing!

   

Ask For An Interpreter

If there are items you don't understand, call the billing department and your insurer, and ask them to explain. Don't accept bills that use terms like "lab fees," or "miscellaneous fees." Demand an itemization. If you don't get satisfaction from the hospital billing department—and you probably won't—appeal in writing to the hospital administrator or patient ombudsman. Most hospitals have patient advocacy programs that can help you with this.
Some hospitals adopted a Statement of Principles on Hospital Billing and Collection Practices. These hospitals are listed on www.hospitalconnect.com. What this means is the hospitals on this list offer free and discounted care to the uninsured and their policies are available and understandable. If you find that a hospital on this list is not living up to these standards, make a copy of the “statement of principles” and present it to the billing office as well as notify your state attorney general or your state consumer protection office.

   

Don't Trash The “Explanation Of Benefits” (EOB)

Most people are guilty of throwing away the EOB which usually states somewhere on it that “this is not a bill.” Keep it because it explains how much the hospital is charging, what your insurance plan will cover, and what you will have to pay out of your own pocket in deductibles and co-payments. You should check this against your bills and keep it for your records, especially to see if the medical facility billed you for something and your insurance company paid, although your balance may be “0” now, this will count against you if you have exceeded you “cap.”

   

Always Ask For An Itemized Bill And Your Medical Records

Always ask for an itemized bill as well as your medical records to confirm you received the treatments and medications you were billed for. Every state now requires hospitals to provide itemized bills. Write down this contact information of the person that provided you with this information so you may reach them if the itemized bill does not arrive.

   

Pay Cash, Up Front

Most doctors lose thousands each year on unpaid bills and spend thousands on credit-card processing fees and hiring an attorney to file a judgment against you can cost them in the upward of 50% of what the bill is worth. By paying cash up front, your are not only guaranteeing payment, but eliminating the paperwork for the doctor. In most cases you can negotiate up to a 50% discount on your bill.

   

Always Ask For Copies Of Your Medical Records

Before you leave the hospital or medical facility, always request copies of you medical records. Be sure you document the name of the person you spoke to, their contact information, and be sure you get a date on when to expect them if they are not able to deliver them to you before you leave the hospital. By requesting copies as soon as possible, you can avoid the hassle of repeating tests and sending results to another doctor in the future. If you do not receive them by the date promised, be sure to follow up with the person you initially spoke with before you left the facility or hospital.

   

Keep A Journal

Keep track of all tests, procedures; specialists you that visit you etc so you may check this against your bill and with your doctor at a later date to be sure you are not charged for services or item s you did not receive at the hospital. Things can get confusing in a hospital setting, so if you are unable to keep track of these things, have someone do it for you.

   

Find Out The Daily Rate Of The Room

Call the billing department and find out the “daily” rate of the room and what is included. Are the box of tissues included, the meals, the toothbrush and toothpaste, meals, TV and telephone calls? Can you request not to be in a private or semi-private room? Decide what you can live with and without and bring in your own box of Kleenex and toothbrush, or save money by sharing a room with another patient. Assume everything is a-la-carte unless you are told otherwise. Make a list and ask what you can bring in from home. Be sure to document the person you spoke to, the price that was quoted and what was included.

   

Pay Attention To Your Appointment Limits

If you're close to the dollar limit or are about to hit your cap of doctor’s appointments for the year, book half your appointments in December and the rest in January. However, do not compromise your health by waiting for an appointment. Instead, plan to book your annual check-ups for the end of the year, this way if you have hit the “cap” of doctor’s visits or the dollar amount due to an “unhealthy year,” you will not go over your limit by going to an “unnecessary” check up which could have been included in one of your visits.

   

Fight Back Your Denials

If your insurer refuses your claim, fight back and don't delay. Start by going straight to your benefits administrator at work. They may have the answers for you already. If this person does not exist at your place of employment or you have an individual policy, you might have to start with a phone call to customer service. Find out exactly why your claim was denied. If you are not satisfied with the answer, ask to speak to a supervisor. You may find that the claim was coded incorrectly, or the wrong information was submitted. You may have to put your appeal in writing. If this is the case, be sure you include all pertinent information and all requests made by the insurance company on what you should include. Be sure you document everything, including the times of calls and the names of the reps you spoke with, and what was said. Make several copies of the letter and other documents such as itemized bills you may need to include and keep a copy for your records and send a registered copy via US mail to the insurance company. You may also want to send copies to your state representative, the Department of Commerce, your State Health Department, and the Office of Consumer Affairs and of Your State Attorney General's Office.
Every plan has an appeals process that you must follow, some more complicated than others, but don't let that intimidate you. For more information, download the Kaiser Family Foundation's guide to resolving Health Plan Disputes at www.kff.org.

   

Request The “Summary Of Benefits”

For those of you who do not have the time or patients to go through your entire healthcare benefits booklet, request the “Evidence of Coverage” (EOC) or “Summary Plan Description” (SPD). This is a “snapshot” of the plan's eligibility provisions, events that can cause you to lose coverage, your rights to continue coverage when you or your dependents are no longer eligible to participate in the Plan, and your rights to appeal a coverage decision or claim denial and the costs. Be sure you understand these terms and conditions, particularly the “exclusions” section setting out services that may not be covered. Ask your health insurance representative to explain what you do not understand in more detail, such as the out-of-pocket maximum benefit or if there is an annual or lifetime limit on coverage.
Take note of all deadlines and procedures such as how many referrals you can get a year and when the referral expires. Familiarize yourself with the sections and keep the entire booklet in a convenient place that you can easily come back and reference as needed.

   

Ask The Doctor For A Deal

The rate that your doctor charges can be negotiable. According to a 2005 Harris Interactive poll, three out of five adults who bargained with their doctor received a discount. If you're paying out of pocket or face a high deductible, call your insurer's customer service number and ask about the rates it pays physicians in your area, or go to www.medicare.gov or www.cms.hhs.gov (under “physician's fee schedule”) to find out how much Medicare reimburses for the procedure you need done. These prices are typically lower than the sticker price set by providers. Then ask your doctor if he'll accept a similar amount.
More and more insurance companies have begun to post rates online for members, though not for every area of the country. In addition, the 30 most common hospital procedures can be found at www.cms.hhs.gov/HealthCareConInit, the website of the Centers for Medicare and Medicaid Services.

   

Pay For The Entire Visit Upfront

Try to negotiate a rate with the billing department upfront. Once you agree on the price of the procedure, be sure to get everything in writing as well as a receipt. Keep in mind that there may be extra costs if complications occur. This works well for routine procedures and saves the facility the hassle of filing with your insurance company and hounding you for a payment in the end. It also saves you from accruing miscellaneous charges in the end.

   
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