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SOS: MEDICAL BILLS - I OWE HOW MUCH?

Mar, 19 2014

“Oops, sorry.” That was the billing rep for the surgeon’s response when she realized they had used the wrong code for my son’s surgery. Their “oops” was a mistake for which I was being billed $2,000! 

Did you know it’s estimated that 40% to 80% of medical bills contain errors? In 2010, Kaiser Health News estimated that nearly $68 billion is lost to fraud and billing mistakes each year.

I have over 20 years experience in medical billing, so it’s easy for me to spot these errors. But, I realize it’s complicated stuff for most Americans, so I’m sharing my top 5 tips to help prevent, spot and resolve your medical billing issues…

1) Know before you go

Take the time to review your medical policy before illness strikes! For example, what are your in-network and out-of-network deductibles (we recently wrote a great article on the differences)? Being familiar with your specific policy ahead of time will help you spot a bill that seems too high. For expensive procedures, ask for an upfront estimate of your out-of-pocket costs in writing. That way, when the bill comes, you’ll be able to tell if the balance is not what you expected.

2) Correct information counts

The person who checks you in when you see your doctor is one of the most important people you’ll see that day! Why? Because 70% of medical billing mistakes happen up front with the registration process. If this person incorrectly enters your information in the system, the claim will certainly be denied. Make sure every provider’s office you go to has the right information, including a copy of your current insurance card, correct spelling of your name, date of birth, and the name of the “primary insured” on your plan. If you have a secondary policy (for example, additional coverage from a spouse’s employer or a Medicare supplement plan), make sure that information is also correct. 

3) Open your mail

I know this sounds dumb, but mail from your insurance company shouldn’t go directly to the junk drawer. You really need to review it! After the insurance company receives a claim from your provider, they’ll send you an EOB (Explanation of Benefits) – you can also review these on your insurance company’s website. Make sure you read these carefully. I always look at the date of the service, the patient’s name, the procedure and cost. If there are any mistakes or it doesn’t jive with what you were told, call the provider’s office and let them know. Make sure you document who you spoke to and the action they will take to correct the claim.

4) Don’t believe everything you read…

…especially when you get a bill from your provider. You might not owe the balance due. When the bill comes from your provider, compare it to the EOB. Does the bill from the provider match the amount in the “patient may owe” column on the EOB?  If it doesn’t, check the following items:

**Did the provider subtract the “contractual adjustment?” This is the difference between your provider’s retail price and your insurance company’s negotiated price – it’s the amount the provider must write off (and not bill you for) because of their contract with your insurance company. This is the most common billing mistake, so be on the lookout!

**If you have a secondary policy, be sure the contractual adjustment for that policy is subtracted. Real life example: I had a friend who was billed $900 for several radiology exams. We compared the bill from the provider to her EOBs and noticed the adjustment for the secondary policy was not posted to her account. A quick phone call to the providers billing office confirmed the mistake and the account was corrected. She didn’t owe a dime! 

5) Get some help

If you’re overwhelmed by multiple medical bills and you’re not sure what you truly owe, get some help from a professional. A Patient Advocate can help you sort through all the bills, review the claims and contact the providers and the insurance company on your behalf. They can even negotiate a reduced balance or payment plan! There are many resources: use an independent company, talk with your employer’s HR department or check with your insurance company see if a Patient Advocate service is part of your plan.

Now it’s your turn! Did you ever get a medical bill that was wrong? What steps did you take to get it resolved?

Adele O’Reilly

Adele O’Reilly has over 20 years of experience in healthcare management with extensive knowledge of patient advocacy, government and commercial healthcare plans. She loved being a freshbenies member so much that she joined the team in 2013. Her passion is to help people navigate the healthcare system successfully with simple yet practical advice. Adele lives in Frisco, TX with her talented, musical family and enjoys writing plays in her (very little) spare time.

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