These are dark times for healthcare, or more to the point, the people who rely on them. People are getting sicker, fatter by the minute. On average, an American will use his or her health insurance plan 10 times this year. You will in fact probably see a doctor four times this year, more if you have children.
A price tag is attached to all these.
It does not mean you have to pay your medical bills right off the bat. Often, doctors do not bill your health insurance company properly. So they bill you directly. They probably would not take the initiative to give you back the overcharge until you ask for it.
So what to do when you get a bill from your hospital or doctor?
1. Don’t pay it.
At least not right away. It may sound counterintuitive, but just because someone has a stethoscope and an air of authority does not mean you have to fork out money, stat. Most insurance companies usually take 60 to 90 days to process claims – longer if your doctor does not submit bills electronically. Even so, it is not unheard of insurance companies to take 120 days, even five years, to process claims, notwithstanding the mode of submission.
2. Review your Explanation Of Benefits (EOB).
That is, if you had the foresight to hold on to it and keep it somewhere. An EOB tells you upfront what part of a bill your insurance can foot.
Call your insurance company if you can’t place your EOB. Find out what portion of the claim has been paid. Afterwards, settle only the sum that your company has estimated that you are obligated to.
3. Jot everything down.
Make sure to put in writing the names and numbers of anyone you phoned from your insurance company and the time of your call. You’ll never know when you’d be asked to reference it.
4. Contact the provider.
Following a call to your insurance company, contact the provider and query them about the bill. If they appear puzzled, just bring up what the representative from the insurance company told you. Writing down details of this phone call makes great sense. You wouldn’t want to seem reckless with details later, saying, “I talked to someone in your office and she said…”
5. Call insurance company again.
You would also appreciate later that you committed names and other details if this call.
6. Contact the state board.
Once a dispute becomes obvious and you sense that you are being ripped off, it’s time to contact the medical board and the state insurance commissioner.
7. Confirm the mail you send.
Fill out appropriately any letter you receive from your insurance company thereafter. Have it copied and send it back to them ASAP. Then contact them after 10 days to ascertain its receipt.
Who Answers To Whom
State boards keep watch over healthcare professionals. Hospitals, on the other hand, are under the watch of state hospital boards. Insurance companies are policed by the state insurance commission. The Attorney-General has oversight over all.
Glossary
Balance Billing – when a contracted provider charges you the full amount for their services.
This is unlawful. If you can sniff out this activity, give a heads-up to the fraud department of your insurance company. You may also send missives to medical, chiropractic, osteopathic, and other concerned boards about what happened. Your letter, along with many others, is enough to build a case against this provider. Try informing the Attorney-General too.
Quick Billing – when a provider sends you a bill for their services immediately and does not wait for the insurance company to process your claim.
Dual Fee Billing – generally refers to charging varying amounts for otherwise one service.
Capitation – refers to an amount of money that your employer established as the highest payment for any particular benefit. May also refer to the act of giving a fixed amount of money for a doctor to see a certain number of patients. The doctor may even get additional incentives by closing their clinics for a period of time and ignore diagnostic protocols.
ICD-9 – international codes of diagnosis. They convert common diagnostic terms into digits.
CPT – codes for procedure terminology. Doctors charge for these.
Co-payment – amount you are obliged to pay for every visit to a certain provider. It may be immediately related to UCR or the “usual, customary, and reasonable” fees established by insurance companies.
Deductible – amount you should pay before getting the insurance company’s payment. This amount is relative to UCR fees.
Enlighten yourself
Not every doctor is unscrupulous. Many times they are just as unenlightened as you in terms of insurance. So are insurance companies.
Problem comes when doctors and other healthcare professionals bill you improperly. Most patients imagine it is their insurance companies deliberately holding up payment.
Educate yourself and learn to justify your bill before paying it.
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