Regardless of what might happen to the Affordable Care Act once the new administration takes office in January, what appears most certain to continue is that all of us must become more responsible for the financial side of our healthcare. This means that we are now in a world that requires that we know what we don’t know, and if we aren’t up to the task of learning the ins and outs of the insurance maze, we’ll need to find the assistance of someone who does to ensure that we aren’t paying for inflated or unnecessary medical bills.
Here are a few suggestions on how to minimize your risks for unexpected medical bills:
ASK ALL OF YOUR BILLING QUESTIONS BEFORE YOU GET TO THE OFFICE/FACILITY
This includes:
Confirming if the provider is in or out-of-network
Requesting from the provider all procedure and diagnosis codes that will be billed so that you can confirm with your insurer how they will process those codes and what you will be responsible to pay
Asking the provider if there are any additional fees for the services provided like room charges and instrument trays, in the case of office surgeries. Some of these fees may not be covered by your plan.
Inquiring if any payments are required at the time of the visit. This will red flag charges that might be unexpected. Often charges required at the time of the visit, besides copays, are expenses not covered by most policies.
Requesting registration information so that you can review the financial policies in advance…again to red flag costs that you might want to avoid.
Asking if you will receive bills from any other facilities/providers that might be involved in your care, like labs, anesthesiologists, pathologists. Outside providers’ fees are separate and distinct from the fees charged by the provider you are seeing.
TAKE THAT INFORMATION TO YOUR INSURANCE COMPANY AND DEMAND TO KNOW YOUR FINANCIAL LIABILITY FOR THOSE SERVICES
This is the time to review copays, deductibles, coinsurances, and non-covered expenses. If the representative you are speaking with cannot answer your questions fully, ask to speak to a supervisor. You are entitled to get detailed answers from the insurer. Not all phone representatives can provide that information, so you need to be assertive to connect with someone knowledgeable.
KEEP EXTENSIVE NOTES OF ALL CONVERSATIONS (DATES, TIMES, NAMES, OUTCOMES, NEXT STEPS)
If you receive an unexpected bill, it will be helpful to have detailed notes of past conversations that might support your argument.
PROTECT YOUR IDENTITY: NEVER GIVE YOUR SOCIAL SECURITY NUMBER TO A PROVIDER/FACILITY
It is not necessary for claims processing…no matter what you are told.
COMMUNICATE ANY SPECIFIC BILLING NEEDS TO THE DOCTOR BEFORE OR AT THE LATEST, DURING YOUR VISIT
The time to ask to waive fees is before those services are provided. If you have done your homework, you will know your financial responsibility in advance and should be prepared to request changes in care or changes in fees for that care.
AFTER THE SERVICES ARE PROVIDED AND THE CLAIM IS PROCESSED BY YOUR INSURANCE, REVIEW THE EOB AND COMPARE IT TO THE FACILITY BILL TO ENSURE ACCURACY
Be sure that your financial responsibility listed on the explanation of benefits from your insurer matches the bill you receive from the facility. If not, you need to research the discrepancies and make sure that the answers make sense. Don’t ever pay a bill that is more than what your insurer says you should owe, without a complete explanation.
KEEP QUESTIONING THE PROCESS UNTIL YOU ARE SATISFIED WITH THE ANSWERS… OR GET HELP
Making assumptions can only lead to negative financial consequences, whether you pay bills that shouldn’t have been paid, or ignore those same bills. In either case, you are jeopardizing your wallet and credit unnecessarily. There are experts who handle these issues and can provide assistance.
Why is the approval of services by an insurance company, does not guarantee the payment of services?
When reimbursement does not cover the total amount of the claim (which the provider got an approval for), the patient is billed (by the provider) for the balance of the unpaid services. Why is the insurance company sending the EOBs to the provider only?
The patient should be informed by the insurance company, why the claim for service(s) was not totally paid.
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