The Life Transition Blog

Medical Billing Advocate Shares Tips

Certain patterns seem to emerge again and again. During a recent phone call with a new client, I began to feel like I should produce and automated recording since my initial conversation with consumers regarding the medical bill woes so often sound the same. As a result, here's my list of the top five mistakes people make when dealing with medical bills.

Mistake # 5: Ignoring the mail
Why is it that so many of us receive mail from a medical provider or insurance company and put it in the "I'll get to it later" pile on the kitchen counter, often unopened? The most common responses I receive when I ask a client "why" include:

The paperwork intimidates me

I don't understand what I'm looking at

I have insurance, so I don't need to review this stuff

I can't pay it anyway, so why open it and stress out about it?

While I can certainly understand each of these reasons for avoiding the medical bill mail, the reality is that taking this approach is very likely to come back to haunt you in the form of being sent to collections.

If you don't understand the bills or explanations of benefits (EOBs) you receive following a medical service, ask someone to explain them to you. You can call the patient billing specialist at your provider or try the customer service representative for your insurance plan. If necessary, you can enlist a medical billing advocate to help. Everyone needs to review their medical bills and how the claims were processed, even if you believe that you have "good" insurance or Medicare and a supplement. Billing mistakes can and do happen, and you, the patient, are often responsible for paying for them. While you have the right to appeal, you must do so within the timeframe required by your plan. By ignoring the mail, you risk missing this important appeal deadline. If you're worried that you can't pay what you owe, you're always better off to negotiate a payment plan and possibly a reduced charge than to simply ignore the demands for payment and end up damaging your credit.

Mistake # 4: Not asking for (and then reviewing) itemized statements
The best way to avoid medical bill problems is to make sure that the charges are correct in the first place. While no one expects you to be an expert in medical terminology, by requesting and reviewing a detailed itemized statement following every episode of care you can often avoid some of the obvious problems. For example, I recently saw a man's bill for his annual physical. The charges included a line for a pap smear which even most lay people know is a test that is only performed on women. Had he reviewed the bill right there at the check-out window, that charge would have been removed before the claim was ever sent in to the insurance. I also recently saw a hospital bill that itemized 77 of the same item at $198 each. That's more than $15,000 of charges. This item is something that no one could have done to them 77 times in the space of a three day hospital admission. Can you guess? We're talking about a urinalysis. Not only was the charge itself very high but the number of tests just didn't make any sense. If this patient had requested and reviewed the bill, I'm pretty sure she would have picked this up. Always take the time to ask for and look at an itemized bill and if you see something that doesn't make sense try to get it resolved immediately. If you feel you are being charged for services you did not receive, ask for a copy of your medical record. A medical billing advocate can match what is documented in your chart with the charges applied to your account and if she finds discrepancies, she can use this to negotiate with your provider.

Mistake # 3: Not asking for what you need
Many insurance plans limit the amount of services you are eligible for under your plan. For example, physical therapy visits are often limited to a certain number within a period of time. While this works out okay in many instances, sometimes a patient just needs more sessions in order to optimize her recovery. When that happens, asking your physical therapist and/or physician to write a "letter of medical necessity" IN ADVANCE of the provision of services. Don't wait until you've run out of visits before you ask your providers to help advocate for you. It's your responsibility to be aware of the limits on your policy and not to just assume that your providers are on top of it.

In other situations, doctors will prescribe a certain drug, not realizing that a particular patient's plan only covers a less expensive alternative. There is no way that a physician can keep track of the frequently changing approved drug lists for each of her patients, so if you, the patient, go to fill the prescription and found out that the drug your doctor prescribed is not covered, it is perfectly reasonable to let your doctor know and find out whether something that is on the list will be a reasonable alternative. If your doctor feels very strongly that you need the specific drug, don't hesitate to request that the doctor's office make a phone call or prepare a letter of medical necessity. He may not succeed, but if you don't ask you definitely won't get the intended medication.

Mistake # 2: Not reading what you sign
What can I say? You know that you should never sign something you haven't read and understood. When the clipboard is shoved in your face, it's tempting to just "Sign here." However, when you do that, you are making yourself responsible. Another tricky point is signing for someone else. If you are the caregiver for a patient who cannot sign medical paperwork himself, it is very important not to sign your name. When you do, you are accepting financial responsibility for your care recipient. Instead, if you hold power of attorney, it's better to sign their name and then your own name alongside it with "as power of attorney" noted. If you don't hold power of attorney, it's better if you don't sign at all. If the provider insists on a signature prior to rendering treatment make sure you sign your care recipient's name and then your own name and add "as representative". Whatever you do, don't accept financial responsibility for another adult, even your spouse.

Mistake #1: Not understanding your coverage in the first place
The most common mistake I see are patients who have no idea how their insurance works and are shocked and confused when they owe money for medical services. It is critically important that you as the consumer take responsibility for understanding how your health care is paid for, what is covered, the types of services that require referrals or pre-authorization, and so on. As painful as it can be to take the time to slog through this material at the start of each plan year, the more informed you are the more benefit you will receive from the coverage that you have.

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