How to Avoid Unnecessary Medical Bills

Everyone at one point or another has had medical bills of some kind. Whether the bills are existing or are yet to come there is valuable information that people must know to not lose money unnecessarily. No matter what kind of medical bill it is it is vitally important that you understand your policy and have fully questioned both your bill and even the Explanation Of Benefits that comes from your own insurance company. Being an informed patient will take much time and patience, but will save you money in the long run.

Instructions

Difficulty: Moderately Challenging

Things You’ll Need:

• Paper
• Pen
• Calendar
• Phone(Fully Charged)
• Time & Quiet Place To Talk

1. Understand some basic information in your insurance policy. You don’t have to memorize the whole booklet, just know and understand some basic info and be willing to look up the rest as it is needed. The following is what you should remember without looking it up(including dollar amounts): whether your policy requires preferred providers(& if so make sure you are using them), whether your policy requires prior authorizations &/or referrals( & making sure you are getting them) deductibles, copays and payment percentages. Knowing this information will save you much time and possibly money by being able to make important health care decisions before you end up with a bill you did not anticipate.
2. f you understand and apply the information above you shouldn’t need to look up information every time you go for a basic office visit for say a cold for example. But for anything out of the ordinary such as for specialists and procedures it is wise to look up information in your booklet before you go. After you find what you are looking for call your insurance provider to get further info and to verify what is in your booklet. It is absolutely crucial that you understand and follow what your booklet and insurance provider tells you. Also if you are about to have an expensive test or procedure done I would suggest calling on two separate days to your insurance provider so that you can verify what you need to do with two different representatives. During your conversations always make note for your records the date, person you spoke to and everything they said and if necessary ask them to repeat what they said so you can write it down.
3. Once you start getting medical bills you should not pay them without first making sure you have an Explanation Of Benefits statement (or as insurance billers like to call it- EOB) to verify that the bill is something you should pay. Just because you receive one, two or even three bills does not mean that you are necessarily responsible for the expenses. Some insurance companies send out EOBs to you for every medical bill, some only send them out for bills that you owe and yet others don’t send them out at all and expect you to get them online. If you receive a bill you can call and talk to an insurance representative and request an EOB. If it is truly a bill that you owe you can request the medical provider to send you a copy of theirs as they receive EOBs to let them know how to bill you. An EOB will either give details about how much was paid by the insurance company and how much the patient is responsible for or it will have rejection codes as to why it was not paid.
4. Once you have the EOB matched up for the same date of service as the bill and are looking at the same procedure you will need to read the EOB. Some insurance companies make this easy, while others are very complicated. The EOB will either show that the bill has been paid or denied. Whether paid or denied you should be able to match up the billed amounts so that you are sure that you are looking at the same procedure. If the bill has been paid it should list the amounts that should have been written off by the provider and any amounts that should be paid by you toward the deductibles and copays. The EOB amount owed should match the amount the provider states that you owe. Note: insurance companies make mistakes so double check the amounts they list on the EOB with what your policy states. For Example if physicals are covered at 100% and you got a bill for labs paid at 80%(cause all other labs are paid at this rate) you will need to call your insurance company to resubmit the bill. Also remember to keep the insurance biller informed so that you do not continue to get bills in the mail. If you had just paid this bill and not questioned it, no one else would have either as normally once an EOB shows as paid the insurance biller then transfers the financial responsibility to the patient. This is where it is important for you to understand your insurance booklet information.
5. If the EOB shows that the procedure is being rejected for payment that still does not mean that you are responsible for the bill. Understanding why it was rejected is important and may require you to call your insurance provider to get further info. Remember to take notes when you call. Rejections sometimes are due to biller errors for diagnosis codes for example or other such reasons. Rejections are also sometimes due to provider errors. If your provider was participating with your insurance company that means they have a contract and sometimes providers do not do what is necessary to get paid per this contract. For example one of the hospital bills that I once got had to be written off because the hospital didn't get the necessary prior authorizations and their contract stated that they were responsible for this. Your insurance provider will have their own contract with your provider with their own set of rules so please be aware of this and follow what is your responsibilities.
6. After you have questioned and followed the above steps and believe that the bill is truly your responsibility then go ahead and pay it.

Tips & Warnings

• Insurance regulations, laws and policies change all the time and are different from state to state so keeping up with these changes is important if you don't want to pay bills unnecessarily.
• To save you from paying medical bills unnecessarily will take a considerable amount of your time both to understand your policy and to talk to the billers of the providers and your insurance company.
• If you don't work the system you may end up getting bills you would not otherwise have gotten had you understood your policy that you pay for in the first place.