Billing errors can be the result of human error or even fraud, and knowing how to decipher a medical statement can be a money-saving skill. Before paying a medical bill, ask yourself the following questions:
A single hospital stay can result in a bewildering amount of bills covering a number of services and providers. Some statements may provide little detail to justify the charges while others may include descriptions or codes that make little sense to the average person.
“There are a lot of billing errors,” says Tom West, creator of the Lifecare Affordability Plan, which helps families make decisions about long-term health care.
Billing errors can be the result of human error or even fraud, and knowing how to decipher a medical statement can be a skill to save money. Before paying a medical bill, ask yourself the following questions:
— Do I need an itemized invoice?
“Do I recognize all the charges?”
— Are the dates and suppliers correct?
— How old is the bill?
— Are there any red flags that this is a medical billing scam?
— Has my insurance been billed correctly?
— Have I been billed for an out-of-network provider?
— Can I negotiate the balance?
Do I need an itemized invoice?
Some suppliers send invoices that include the total due and nothing else. It’s for good reason, according to an industry expert.
“Descriptions of services provided on a medical bill or benefit statement are intentionally a little vague,” says Anthony Lopez, general manager of individual and family plans for eHealth, a private health insurance marketplace. “Medical providers and insurance companies must adhere to strict regulations designed to protect patient medical confidentiality.”
While more detail probably isn’t necessary if the bill is for a single office visit, the complex procedures that come with a hefty price tag are worth a closer look. “You absolutely have to call your provider and say, please explain these fees,” says Shobin Uralil, co-founder and COO of Lively, a provider of health savings accounts.
Some providers make it easy to get these details, and you may be able to log into an online account and view a digital invoice. However, if you receive paper statements, you will need to call your provider to request a breakdown.
Do I recognize all charges?
Once you have an itemized bill, review everything listed to make sure it matches your records or your memories of the care you received. Don’t automatically assume the information is correct.
Invoices are processed on the basis of a coding system, and these codes are entered by hand, which means that there is always a risk that a worker presses the wrong key. “You might accidentally be charged for the wrong service,” says Uralil.
However, it can also be an insurance issue that makes a bill look bad. “Patients need to be clear whether the issue is related to the bill from the healthcare provider or the payments made to the provider by the insurance company,” says Will Reilly, vice president of marketing for R1 RCM, a revenue cycle management. serving health care providers.
Contact your provider’s billing department with any questions. If you need to dispute an invoice, also contact your insurer. They may have staff who can help with billing issues.
Are the dates and suppliers correct?
Beyond looking at the fees themselves, double-check the dates and providers listed. This can be especially important for hospital stays when bills can be generated every time a doctor stops by to check on your condition. If you didn’t see a specialist on a particular day, you could end up paying more than necessary.
“If you think the medical provider is actually charging you for services you never received, call them to let them know your concerns,” Lopez says. “If they insist the claim is correct, call your insurance company to let them know and ask them what your next steps are.”
Are there any red flags that this is a medical billing scam?
Most billing issues are the result of human error. However, you need to be careful of medical billing scams.
Some scammers may send bills that look legitimate but are for fake services. This is one of the reasons to carefully check the dates and the names of the suppliers. Other red flags may be a billing address that does not seem familiar to you, requests for sensitive information such as a Social Security number or phone calls claiming to be from Medicare. Just like the The IRS won’t call peopleMedicare representatives generally do not contact patients by phone.
How old is the invoice?
It may take longer than you think for a medical bill to arrive in your mailbox. Many insurers require providers to bill them in a timely manner, but this can still take months. Once a bill is sent to the insurer, healthcare providers must wait for payment before billing the patient for the balance.
While your invoice is going through this process, your deductible may have been paid in the meantime. In this case, the insurance company will pay the full amount. If you receive an old invoice, check the status of your deductible and if it has been met, ask your provider to re-invoice the insurer.
Has my insurance been billed correctly?
If a bill is higher than expected, confirm that your insurer was billed correctly. “You want to be sure that the insurance is listed on the bill you receive,” says West.
Along with your bill, you should also get a separate statement from your insurance company for each bill you receive. “This document confirms that a claim has been submitted to your plan by a medical provider,” Lopez says.
Compare your itemized statement to the explanation of benefits provided by your insurer to confirm that they were billed for the same services. If a service appears on your statement but does not appear on the EOB, contact your provider to ask your insurer to be billed.
Using technology and online solutions can make this process easier for consumers, according to Reilly. “With a digital approach, patients should be able to manage everything from one consolidated view,” he says. “It puts bills from hospitals, doctors, and other clinicians in one place next to EOBs so patients can clearly see charges, insurance payments, and out-of-pocket expenses.”
Have I been billed for an out-of-network provider?
Surprise billing, or balance billing, occurs when a patient believes they are receiving care from an in-network provider, but the healthcare provider or facility is actually out of the network. For example, a person can be admitted into a network hospital, but a specialist service provider is not part of the network. Consequently, an insurer may refuse to cover all or part of its costs.
In recent years, many states have enacted surprise billing laws, but their provisions vary widely. In January 2022, the no-surprises federal law went into effect to provide consumers with nationwide standardized protections.
Among the provisions of the law are the prohibition of surprise bills for emergency services, out-of-network cost sharing for emergency services and certain non-emergency services and out-of-network charges for out-of-network providers who work in a network installation. Consumers who believe they have been incorrectly charged for these services can call the government’s No Surprise Helpline at 1-800-985-3059 or complain online.
Can I negotiate the balance?
Don’t assume you have to pay the total shown on an invoice. Hospital collection rates are not very high, especially for emergency room visits, and providers may be happy to offer a discount in exchange for cash payment. If you negotiate an invoice, be sure to get the agreement in writing.
It’s even better if you plan to negotiate the price before an elective procedure since that’s when you have the most leverage to obtain a reduced rate. “The best defense against unexpected bills is to ask ahead,” says West.
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