This is a relatively new field of work, one that is gaining interest from consumers and employers, who have become increasingly motivated to seek ways to minimize the costs associated with their health care. Health care is expensive. Most people believe that having health insurance completely protects them from having to shoulder the costs of medical services. Nothing could be further from the truth. While costs for medical claims, to some extent, can be controlled by using in-network care, increases in deductibles, copays, and coinsurances, a percent of a charge that a patient is responsible to pay, are suffocating consumers and endangering their financial welfare.
A large part of the problem is that most people do not understand, nor care to understand, how doctors and medical facilities get paid, until they are responsible for an unexpected medical bill. The process of billing for medical services is anything but straight-forward. If you don’t work in health care, you probably know little about how claims are submitted and processed. This means that it is very difficult to know how to evaluate a medical bill to know what you are truly responsible to pay.
The best approach to managing your financial responsibility for medical care is to ask questions of your medical provider about the billing of their services in advance of receiving that care. When that is not possible, then Plan B involves a systematic review of each line item charged to ensure that the claim was submitted correctly, that it was processed completely by the insurance company, and that the bill you have received is accurate and appropriate. Ignoring any of these steps means that you could be a victim of a costly billing error…something that occurs in nearly 80% of all medical bills.
This is where a medical billing advocate, or patient advocate, comes into play. The most effective advocates are those with a long history in medical billing. Since they are experts in the minutiae of line-item billing, they understand the language of medical billing. They understand coding of services and can recognize if a claim has been over-inflated through aggressive coding. They know how to read an explanation of benefits (EOB) from an insurance company and can compare it to a patient bill to ensure the accuracy of the charges. They know how to speak with providers and insurance companies when issues arise. And they know the most effective ways, including negotiating medical bills, to resolve those issues and reduce costs for the patient.
While resolving a medical bill dispute is one of the most critical and immediate services a medical billing advocate can provide, a second tier to their value is the educational guidance they provide that can help you avoid excessive medical bills in the future. They serve as a resource for their customers, helping them know the right questions to ask in advance of their care so that they avoid incurring unforeseen medical expenses, including the cost of prescription drugs.
In today’s world of healthcare, you need to know what you don’t know. And if you aren’t willing to learn, you need to find someone who can. In those instances, protect yourself from medical debt by contacting a medical billing advocate.