Better Health & Living
Beating the Medical Bill Blues
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If you can’t decipher your medical bills, think that a charge isn’t quite right, or notice that you’ve been billed for treatments you never received, you’re not alone. In one survey of more than 10,000 Americans, 1 one in 20 said they’d found serious mistakes when they looked closely at their hospital bills. In another, an irate 60 percent said they’d been surprised by charges they had expected their health insurance plans to cover.
“Straightening out medical bill problems is a huge challenge, especially if you’re ill or taking care of someone who is,” says Lisa Norris, president of the Association of Claims Assistance Professionals and owner of the Torrance, California—based ClaimCare service. “Millions of pieces of paper show up in your mailbox. It’s tempting to ignore them or just to pay every single one, especially when you don’t have the time or emotional resources or the knowledge base to battle all of the Byzantine rules and regulations.” Here’s how you can resolve a medical bill dispute—or avoid one in the first place.
I just received a bill for a minor medical treatment that seems exorbitant. Should I just pay it?
No; it could be a mistake. Call your insurance company and your doctor’s billing department and explain that the bill doesn’t look right. Tell the insurance company what your diagnosis and treatment were and ask if the codes on the bill match those. Ask for a copy of the explanation of benefits notice for the bill to see what was covered and what wasn’t. Question everything that wasn’t covered—you may find the problem there. Ask your medical provider for an itemized bill to see if there were obvious charges for things you didn’t receive or shouldn’t be billed for at all—such as procedures or treatments you didn’t get or even small items such as tissues or hand lotion during a hospital stay.
What should I do about an enormous medical bill that I can’t afford to pay?
First, keep talking with the hospital or medical practice that’s billing you. Ignoring a bill won’t help—it could be passed quickly to a collection agency. If it already has been, call the collection agency immediately and tell them the bill is in dispute. This should give you a longer deadline so you can figure out what to do.
Second, gather all of your bills and the explanation of benefits notices from your insurance company. It’s quite possible that there are errors and that you don’t owe as much as you’re being billed. The error could be as small as an incorrect diagnosis code, incorrect insurance information, or charges for services that you didn’t receive. If the bills are confusing, ask a friend or relative to review them with you.
If you’re sure the bill is completely correct, talk to the hospital or medical practice about a payment plan that you can afford.
I’m trying to get to the bottom of a problem with the medical bills of an ill relative, and I’m overwhelmed. Is there someone I can hire to help me?
Yes. You can find a medical claims consultant through the Association of Claims Assistance Professionals (ACAP) at www.claims.org or Medical Billing Advocates of America at www.billadvocates.com. Consultants charge between $40 and $125 an hour or get a percentage of recovered insurance compensation. They can cut through the chaos of healthcare paperwork—organizing bills, filing claims, disputing denials, and looking for mistakes. It may be worth consulting one if you owe more than a few hundred dollars and aren’t getting anywhere on your own.
Is there some way to avoid billing problems in the first place?
Yes. First, know as much as possible about what will be covered by your health insurance. If you’re choosing a new doctor, call your insurance company to be sure the doctor is in its provider network so that you get the best coverage. If you’re going to your doctor, a hospital, or a clinic for anything beyond a routine visit, call your insurance company first to see if you need a preauthorization for a procedure or treatment. Ask your doctor to estimate treatment costs, too.
Second, keep good records. When you receive a medical bill, don’t pay it until you receive the explanation of benefits notice from your insurance company. This shows what your provider has billed, what the insurance company will pay, and the amount that you’re supposed to pay. Read them both to be sure there are no mistakes.
Third, stay on top of insurance claims. More and more providers don’t file them for patients, so it’s up to you. And if you’re covered by two health insurance plans, don’t assume that anyone will bill the second one; usually, you have to do that.
By Susan Flagg Godbey and the editors of Better Health & Living®
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