Checking your Healthcare Bills- It's important!

Okay y'all.   I am at the point of my career where it starts to tell my age how long I have been involved with health care.  Before had kids, I would get my annual exam with my OB/GYN and maybe a physical since it was covered by insurance (AKA no co-pay and free for yearly lab work). I highly recommend everyone start trying to find a healthcare provider that they like and trust.  It can take a while.  And is important to see someone consistently. I am seeing so many people treated incorrectly an increase in medical errors and a surge in the overprescription of medication that is unnecessary. Often it's because patients are not followed properly due to others not having a PCP. They see a different provider at different urgent cares and there is not any consistency. 

 Okay, I will get off my soapbox now. 

I wanted to shed some light on medical bills.  I did not have a fair share of medical bills until I had my first child and it was overwhelming.  4 years later, I have seen multiple issues and I have gotten quite comfortable calling the billing department and my health insurance company or representative.  I have often seen where the office does not run your bill through your health insurance, they just send the bill to you.  If you did not know better, you may pay the thing entirely without realizing your insurance should have paid for a portion of that.

Just in the last 12 months, I had to fight with my representative to ensure that the Children's Hospital that is local to us accepted my health insurance.  They sent me the entire bill and said they do not cover it because he was inpatient and we were out of network.  I was furious.  I had done my due- diligence and ensured when we moved insurance plans that our new one was accepted at the Children’s Hospital 25 minutes away. After about a month of back-and-forth, they realized that they had billed incorrectly and that the hospital did indeed take our health insurance.  It is the hospital's responsibility to tell you that they do not accept your insurance before they admit to your child to the hospital. Which also did not happen. 

For this same visit, I caught a huge coding error.  They tried to say that we were the highest level of care, this would be equivalent to a traumatic car accident, being life-flighted, a truly emergent and traumatic hospital visit. My kid was seen for respiratory issues, did not have to be on oxygen, and did not have to have an IV, it was urgent but it was certainly not what they coded for.  So I fought back about that as well.

Lastly, I saw a PCP for a visit.  My co-pay should have been $30.  They sent me a bill for $600, then they called me over and over again and sent multiple letters about how I owed 600 bucks.  I called the billing department to let them know that they should run my insurance first and I should only have a co-pay.  5 months later, the bill finally disappeared.  If I had not known better, I may have paid this to avoid being flagged by collections.  Affected my credit scores.  Money out of my pocket.

One question that I often get is "What is the difference between my deductible versus out-of-pocket?"

Your deductible means once you hit a certain dollar amount, your insurance begins to pay a portion of your bills.  For example, if you are deductible is $4000, you will pay every medical bill, ultrasound bill, and pharmacy bill until you hit $4000 and then your insurance will begin to pay a portion which is usually between 70 and 80% of the bills.  Then, if your max out-of-pocket is $8000, once you have paid $8000 of your own money, your insurance pays for everything at 100%.  This number varies based on your insurance but that is a breakdown to better understand what the two numbers mean. Additionally, there are usually in-network and out-of-network- there may be separate numbers for each. Be sure to ask if your insurance is accepted and if you are ‘in-network’ so that you know in advance. 

It is important to scrutinize your medical bills, it can be financially devastating if you do not.  Let's talk about how to approach the assessment of medical bills and to protect yourself in your wallet.  We will talk about what to look for, what to do if you find something you think may be incorrect, and what that impact may look like.

Understanding the Importance:

Financial Implications:

Medical bills often constitute a substantial portion of an individual's expenses, especially in countries where healthcare isn't universally accessible. A single error or overcharge can lead to financial strain, compounding an already stressful situation. Moreover, unresolved discrepancies can negatively impact credit scores and lead to debt collection efforts, adding further stress and complications.

Common Billing Errors:

Medical billing errors are more common than many realize. They can stem from various sources, including coding mistakes, duplicate charges, services not rendered, incorrect insurance information, and more. These errors can result in inflated bills, unnecessary out-of-pocket expenses, and insurance coverage denials.

How to Scrutinize Your Medical Bills:

Gather Documentation:

Start by collecting all relevant documents, including itemized bills, insurance statements, explanation of benefits (EOB), and receipts. These documents provide a comprehensive overview of the services rendered, associated costs, insurance coverage, and payments made.

Verify Services:

Carefully review each service listed on the bill and compare them with your records and any medical notes you have. Ensure that each service corresponds to the treatments or procedures you received. Look out for any discrepancies, such as duplicate charges or services you didn't receive.

Check Billing Codes:

Medical bills typically include billing codes that correspond to specific services or procedures. Verify these codes against your medical records to ensure accuracy. Coding errors can result in incorrect billing, leading to inflated costs or insurance coverage denials. If you want to know what the code means, google it! 

Confirm Insurance Coverage:

If you have insurance coverage, cross-reference the billed amounts with your insurance statements or EOBs. Confirm that the insurance has been accurately applied and that you're not being billed for services already covered by your policy. Pay attention to co-pays, deductibles, and coinsurance amounts.

Calculate Totals:

Verify the total amount billed against the sum of individual charges, insurance payments, and any out-of-pocket expenses you've already paid. Ensure that the totals align and that there are no discrepancies or unexpected charges.

What to Do If You Find Errors:

Contact the Provider:

If you identify any errors or discrepancies, promptly contact the healthcare provider's billing department. Provide clear documentation of the discrepancies and request a detailed explanation. Be polite but assertive in your communication, emphasizing the importance of resolving the issue promptly.

File an Appeal:

If your insurance denies coverage for certain services or procedures, file an appeal with your insurance company. Provide any necessary documentation, such as medical records or physician statements, to support your case. Appeals processes vary by insurer, so follow their specific guidelines.

Seek Assistance:

If you encounter challenges resolving billing discrepancies on your own, consider seeking assistance from patient advocacy organizations or legal resources specializing in healthcare billing issues. These professionals can provide guidance and support in navigating the complexities of medical billing and insurance.

The Financial Impact:

Cost Savings:

By diligently scrutinizing your medical bills and rectifying any errors or overcharges, you can potentially save significant amounts of money. Correcting billing errors ensures that you're only paying for services you've received at the appropriate rates, reducing unnecessary financial burden.

Protecting Credit:

Unresolved medical bills can adversely affect your credit score and financial stability. By addressing billing discrepancies promptly, you mitigate the risk of negative credit reporting and debt collection efforts, safeguarding your financial reputation and future borrowing opportunities.

Peace of Mind:

Taking proactive steps to review and correct your medical bills provides peace of mind knowing that your financial interests are protected. It allows you to maintain control over your healthcare expenses, reduce stress, and focus on your well-being without the added worry of financial uncertainty.

In today's complex healthcare landscape, checking your medical bills is not just a good financial practice but a necessity. By scrutinizing your bills, identifying errors, and taking appropriate action, you can mitigate financial risks, protect your credit, and ensure fair and accurate billing. Empower yourself with knowledge, diligence, and advocacy to navigate the intricacies of medical billing successfully. Your financial health and peace of mind depend on it.