TRUTH ABOUT MEDICAL BILLS

Why am I receiving a Medical bill?

You go to the Doctor or are hospitalized your insurance information is collected and then billed, then one day you receive a bill. Why am I being billed and what are the charges for? This is where your explanation of benefits can be a big help...that is if you understand how to read it.

What is an Explanation Of Benefits (EOB)?

An Explanation of benefits or EOB as we often refer to it in the medical field is a document that shows how your claim was processed or denied. Both the provider of service and the patient should receive a copy of the EOB once the medical bill has been processed. The Explanation Of Benefits can reflect either payment or denial of the medical claim. The EOB is then reviewed and either a bill will be dropped to you or any adjustments or corrections on the providers part will be made.

What’s the difference between an Explanation Of Benefits and a medical bill?

The Explanation Of Benefits should be titled Explanation Of Benefits and will not arrive with an attached payment slip. Most bills feature some of the same information from the Explanation Of Benefits but will also include payment instructions. An EOB will not have instruction regarding payment and will come straight from the Insurance company not the provider. I recommend reviewing the EOB to verify if anything is required to be done by you such as information requested from the patient which might be noted. If the EOB sent lists deductible, coinsurance or co-payment amounts take note of these charges. These are patient responsibility and are billed to you according to what is assigned by your Insurance plan as patient responsibility.

Is the amount I am billed on my medical bill correct?

You have the right to ask this question and receive an answer as to what you are being billed for every time. Medical bills can be confusing but you should never be billed for anything that the provider of service cannot explain. Working in medical billing we have guidelines that we must follow when billing the patient. If you receive a bill and it is not easy to understand why the amount billed is your responsibility call the number on your bill. If you cannot get good answers regarding the bill received from this provider you should call the number on your insurance card. Look for the member services phone number on your insurance card. You will most likely need to provide the representative your insurance ID#, name, date of birth, provider name and date of service on your bill.

What should you do as soon as you get a medical bill?

Open the bill and review it as soon as possible.

Compare it with any document you should receive from your insurance company for this same visit. This information may come by mail or might only be available on your insurance companies online portal. If you do not know for sure how to view this I recommend that you contact your insurance company. When you call them or send an online inquiry ask for instructions on obtaining your Explanation of benefits for whatever service was provided.

Contact the medical center or insurance company to update any requested information immediately. You will often receive letters or calls requesting updated information and these must be handled promptly to prevent any additional financial responsibility on your part.

Check to make sure your personal information on file with both the insurance company and the medical center is 100% accurate. This can result in claims not being paid and you potentially receiving bills that you would not otherwise have been responsible for normally.

Taking the above actions quickly can prevent any incorrect billing and help you to understand when the bill is correct and why. Keep in mind there are many situations that we are responsible for charges billed.

Situations where you may be responsible for that medical bill may include:

Coinsurance amount - What is a Coinsurance?

The percentage of costs on a healthcare service that you must pay which is determined by each policy. Let’s say that your percentage is 20% which is pretty typical, this will be the coinsurance amount owed by you after you have met your yearly deductible amount.

Copayment amount - What is a Copayment?

An example of a copayment could be: A specific amount set by each insurance company and paid for by the patient/subscriber at each doctor’s office visit, urgent care, ER, with each prescription refill, etc. This is a set amount owed by the patient before the insurance picks up their portion. Just for example: when visiting a family physician you may pay $15 each visit and for a specialist, your coverage may require a $30 copay.

Deductible balance - What is a Deductible?

A deductible is an amount you pay for health care services which are approved covered services before your insurance plan starts to pay. A $ 1,000 deductible, for example, you pay the first $1,000 of these services covered by your plan out of your pocket.

Lapse in coverage with a health insurance plan

A lapse in coverage can happen when you switch providers or your insurance plan is no longer valid. Did you switch insurance or lose coverage recently? Always make sure if you are insured that your most up to date insurance plan is what the provider has on file.

Non-covered, Experimental or Investigational

Services determined to be non-covered, Experimental or Investigational by your insurance company. Preventing and determining these situations can be tough to do but contacting your insurance company in advance can sometimes help. If you are going to be having a procedure done it can be a good idea to contact the insurance company in advance to verify that they actually will cover it. If a procedure is considered not medically necessary or unauthorized by the Insurance company your insurance company can assign the charges to you. My recommendation in all situations where you are uncertain is to always call and ask your insurance company as many questions as possible prior to services being rendered.

What are my options for payment of my medical bills?

A word of caution do not ignore a medical bill or not respond with payment. You should never wait too long to respond to a medical bill because if you do it will often be sent to collections. What I recommend if you receive a bill that you cannot pay in full is always call the phone number on the bill as soon as possible. There can be options available depending on the provider to help you manage payments.

Payment plans for paying medical bills

Payment plans are often available upon request when you cannot pay in full. Payment plans will allow you to make smaller monthly payments over a period of time with no interest accrued. This is a much better option that loans and credit cards used to pay off a medical bill.

What if I have no health insurance coverage?

If you have no insurance coverage and are aware of this before a procedure or service always make sure the provider is aware. If your income is lower you do not have coverage you might even be able to qualify for financial assistance. Check with your provider in advance or immediately after receiving a medical bill to see if you might qualify.

How to get financial assistance with a medical bill

Are you struggling to pay your bills? You could qualify for financial assistance through many providers just by asking and providing some additional info. I recommend checking with the provider as soon as you receive a bill if you know that it will be difficult for you to pay. Financial assistance is typically available but will be determined based on family size, income, etc. If you don't have health insurance or need help with out-of-pocket costs, you may be able to get financial assistance.

To qualify for financial assistance the provider may require: proof of income as well as other information. The requested information will often include the following: Wage verification which could include up to a year of pay stubs, unemployment information, Social Security letters, self-employment records, disability or worker’s compensation, alimony, child support, pensions, income tax returns, etc. If you cannot pay your bills this could be the best option for you and could save you from being sent to collections for these bills.

What to do when you receive a medical bill?

Many people would think that these things are obvious. However sometimes people look at these mistakes and do no understand their importance. As a medical biller I caution you to make sure that you realize that these minor errors can result in much bigger errors. These errors can lead to being billed for services that you should never have been responsible to pay for normally.

What not to do with a medical bill

Never ignore medical bills or throw them away

Never provide incorrect information to the medical center or forget to update your information when it changes. This information can include addresses, names, new insurance carriers, phone numbers, etc.

If you notice that your new insurance card arrives with your name misspelled, date of birth wrong, etc. Make sure to immediately get this information updated with the insurance company to prevent any future problems.

Medical bills can be confusing

Medical bills can be as simple as a small charge for a recent Doctor's visit or as complex as a bill for a hospitalization or surgery. The bill you receive can vary for many reasons and can have a variety of outcomes. Your own insurance plan determines the portion of the medical bill that you will be charged after the claim is processed.

Since I began working in Medical Billing years ago my knowledge of the process and all that goes into it has broadened. I began to see aspects of the whole process from registration to the patient receiving the bill, which was crucial. Everything started to make more sense overall and I began to identify situations that could be potential additional costs to the individual patient that I had never seen before. Throughout my time in the medical field I have seen several things that people do that I would recommend against.

Below are just a few examples of some simple things that can become very costly mistakes.

Costly (or just irritating) medical expenses you can avoid

Nobody wants to pay more than they owe on their bills..... Overlooking minor or major discrepancies when you first obtain your insurance. Good examples would be : Misspelled names, incorrect dates of birth, incorrect sex listed or address wrong. These are just a few examples of things that might hold up claims processing or cause incorrect billing. This can result in bill being dropped to you in error that would not normally be your responsibility. Trust me it is more important than you think.

Make sure that you always provide the most up to date insurance card at every appointment whether you are going to the ER, Dr. Office that you always visit, New Dr. office or even just getting labs or x-rays performed. They may or may not already have this on file especially if they have recently updated a computer system they are using. Never assume that what they have on file is 100% correct, always verify for yourself.

Did you give birth recently? Make sure that your baby is added as soon as possible to your insurance plan and that yours or your spouses HR department is aware of the birth also. Did you give birth to twins? Make certain that names and all info are corrected for both twins. If you seem to be having issues with any claims being paid for either twin check with your insurance company and or hospital to make sure that there are no issues related to the fact they are twins. Often the Insurance company either has incorrect or incomplete info for one or both twins on file causing issues or it could be the provider billing with the wrong ID#. I have personally seen patient's claims denied as a result of these small but costly mistakes. If they payer denies the child as not on the plan you could be billed for charges in error that you would not owe.

As I mentioned above the incorrect ID# being billed for someone can cause denials on claims. It can cause denials that could even result in a bill accidentally being sent to you that you might not expect.

If I am billed in error how do I get it fixed

If you find that you are billed in error for services provided always contact the provider immediately. Once you speak with someone regarding the bill they should either update any information needed from your or be able to explain the charges billed. If you still cannot get the answers that you need I recommend immediately contacting the insurance company to question the charges billed. If the charges are billed in error and not your responsibility the Insurance company can clarify this and take action on your behalf if the provider will not work with you. Always speak up, ask questions and get answers that you can understand this is your right as a patient.

Never be afraid to ask questions

You have the right to call and get answers when something does not make sense. If you have questions regarding a medical bill that you receive....make that phone call. Each insurance company should provide you with a phone number for members to call with questions or concerns. Each provider of medical services will also provide a phone number for billing questions. As a medical biller I highly recommend that you always get answers whenever something seems confusing. It can help you to catch billing errors or even just better understand your own insurance plan.

I hope that you found this information provided to be helpful. The information provided here should not be considered financial advice, medical advice or legal advice. The information provided if for information purposes only and is just some insight from a woman who has spent over 20 years working in healthcare. If you have any specific questions that I might be able to answer feel free to leave them in the comments below.