As if dealing with an illness or injury isn’t stressful enough, handling the bills and insurance paperwork can add an additional layer of stress to your life. Maybe the doctor’s office or hospital sent you a bill with a mistake. Or maybe your insurance company unexpectedly denied your claim. No matter your situation, it’s important to stay on top of your bills or you may find yourself at the mercy of a bill collector. Fortunately, if you cannot handle all of this yourself, there are professionals who can help you. Our tips for handling medical bills will hopefully make your life a little easier!
It’s all in the details.
There is so much room for errors when it comes to medical bills. A code can be entered incorrectly. You can be confused with another patient. It’s entirely possible to get bills for services you never received. Therefore, it’s important to read over your medical bills with attention to detail.
The same attention to detail applies to your explanation of benefits from your insurer. Perhaps they rejected a service that is normally covered due to a clerical error or a change in policy. But you won’t know unless you read these statements carefully and compare them to the appropriate medical bills.
Yes, it’s all boring. And sometimes frustrating. But it’s necessary if you don’t want to overpay.
Before you make an appointment…
It’s best to avoid unexpected bills. Take these steps before you make an appointment:
Call your doctor and/or hospital to:
- Confirm your coverage.
- Learn if you need pre-authorization.
- Ask about co-pays.
- Determine an all-inclusive estimate of costs, including a breakdown of prices.
Additionally, it’s a good idea to check in with your insurance company to:
- Learn if the services you expect/need are covered.
- Find out if you have met your deductible.
Before you pay a bill…
Don’t pay a bill until you are certain that it is correct AND that the total due matches the amount stated on your insurer’s explanation of benefits. First and foremost, make sure the bill doesn’t contain errors, including duplicate charges. If you didn’t get an itemized bill, you can request one (the law requires providers to give patients itemized bills).
Although you can get refunds for overpayments from hospitals and doctors office, it’s a hassle you should avoid when possible.
If you have a billing question or issue with your doctor or hospital, or with your insurer, call them. But do yourself a big favor and keep track of all phone conversations; write down the name of the person you speak with, the details discussed, and the next steps.
If your insurance company denies a claim, don’t give up too quickly. Send a written letter describing why you think your policy should cover the service in question. Get a detailed letter from your doctor to include. If necessary, ask someone from your doctor’s office to call your insurance company for you.
Help for low-income patients.
Certainly, if you don’t have insurance, a medical bill can devastate your finances. Did you know that in order to keep nonprofit status, the government requires nonprofit hospitals to have Charity Care programs that can cover some or all of your hospital bill if you qualify? If you or your loved one received care at a nonprofit hospital, find information on their charity care program by searching online with the hospital name and the phrase “patient financial assistance”. To take advantage of these programs, you must complete a potentially difficult and confusing application process. Additionally, you may have to persist to get an application since some hospitals deter applicants. However, it can be worth your time and efforts, even if you already paid a bill – you might get a refund.
Hospitals often bill low-income patients.
Disturbingly, a 2019 Kaiser Health News analysis of reports submitted to the IRS found that 45% of nonprofit hospital organizations routinely send medical bills to patients whose incomes are low enough to qualify for charity care. This accounts for 1,134 hospital organizations which operate 1,651 hospitals. This accounts for billions of dollars of medical bills sent to patients who likely would have qualified for hospital charity care programs.
What are the requirements of these programs?
Each hospital can decide the qualifying criteria. For example, a generous hospital may give free care to people earning less than twice the federal poverty level, and may provide discounts for people earning up to double the federal poverty level. But other hospitals may have less generous cut-offs. Additionally, hospitals’ charity care programs can include exceptions, such as not covering bills for doctors who are not on their payrolls.
Not all medical providers offer charity care programs.
Importantly, the law only applies to nonprofit hospitals. And only about 56% of community hospitals have nonprofit status – the rest are for-profit. Additionally, realize that doctors and other medical providers are not hospitals and therefore don’t fall under this rule.
What about “surprise bills”?
“Surprise bills” occur when patients receive unexpected bills from out-of-network providers when they receive care in an in-network facility. How does this happen? Unfortunately, you can receive care from a doctor who doesn’t not have a contract with your insurer, even when your care takes place at an in-network facility. These surprise bills are more common with anesthesia, pathology, emergency rooms, internal medicine, and ambulance bills.
According to a recent study, out-of-network bills are increasing among inpatient admissions and emergency department visits to in-network hospitals. Right now, patients have limited options when it comes to surprise bills, although you can contact the hospital and your insurer to fight back. However, there is some good news. The US government is enacting a ban on surprise medical bills by instituting a cap on the pay doctors, hospitals and air ambulances can collect for out-of-network care. The Consolidated Appropriations Act of 2021 includes the “No Surprises Act” which establishes a federal procedure to handle many (but not all) types of disputed out-of-network medical claims. This new federal law, scheduled to take effect in January 2022, creates a uniform level of protection for all group and individual major medical plans in the US. Importantly, the Act does not preclude states from adopting even stricter rules regarding these bills.
Handling the bills yourself?
If you are handling your medical bills and insurance yourself, take the time to set up an organizational system. It’s critical to stay organized! Keep records of bills you pay and the associated insurance statements of coverage.
Need professional help with inaccurate bills or denied coverage?
If handling medical bills is too overwhelming, or you’re struggling with a claim or bill that you think is wrong, you may want to hire a medical-billing advocate (for a fee). However, not all advocates are equal, so do your homework before you hire someone.
Firstly, ask your friends and family if they know of a reputable advocate. If no one has a lead for you, try Medical Billing Advocates of America, a professional organization for those who help with billing and insurance issues. You can use their website to find a professional in your area. Before hiring help, be sure to speak with past/present customers; and get a written contract detailing the billing rate, services provided, and if they require payment if they cannot reduce or eliminate the medical bill in question.
More tips for handling medical bills.
Read these blog posts to learn more about money related matters:
- How to Save Money on Prescription Medications.
- Can You Comparison Shop for Healthcare Prices? Yes, and You Should!
- How to Shop Around for Healthcare Pricing.
- Reduce Your Healthcare Expenses.
- The High Cost of Healthcare is Keeping Patients from Seeking Care.