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Understanding Medical Bills - Down the Rabbit Hole

Well healthcare has been a topic dujour in the press this week after the U.S. Supreme Court's decision upholding the constitutionality of the Patient Protection and Affordable Care Act.  Whether medical costs can be reigned in by a gaggle of politicians remains to be seen.  One thing is for sure: the bills will keep coming to the patients. 

While the health care industry adapts to the law the public continues to deal with a major headache not adequately addressed by most forms of "healthcare reform": the disputes, confusion, duplicate bills, unknown providers, unrecognized treatments, delays and collections/lawsuits/ bankruptcies which accompany our fragmented medical billing system.  The problems and apparent insanities of the multiple medical billing systems make Alice's "Rabbit Hole" seem like a pleasant vacation on a tropical island.  Let's try to sort some basic issues out to make sense of the paperwork.

When you receive medical treatment you may be billed by several different and distinct healthcare providers.  For example a trip to the ER may result in a hospital facility bill, an ER physician's bill and a radiology bill.  This is not one-stop shopping.  Many times the different providers do not have your health insurance information when they issue the bill.  You must immediately contact them if the invoice you receive does not indicate that insurance was billed!  If insurance isn't billed and you ignore the invoice you may end up personally responsible for the bill, which is often billed at a price far in excess of what health insurers would actually pay.  Always be on the lookout for multiple bills and make sure that the medical provider's billing department is given any applicable health insurance information.

Duplicate charges on a single bill are a fact of life.  If you are insured and your health insurer processes the bills your health insurer will uncover this issue.  If you are paying out-of-pocket or on a high-deductible policy examine your bills carefully.  Look at the itemization and determine if there are charges which are the same and appear to be for the same or sdimilar treatment.  Inquire with the billing departments prior to paying as duplicate charges are common.

Your health insurance rarely pays the whole medical bill.  Medical providers will quickly send your individual bills into collections if you do not timely pay the co-pay or deductible amount due in full.  Even if the amount seems trivial to you.  Timely payment of the co-pays and deductibles will preserve your credit score and prevent unecessary stress.  Don't just toss that bill because it was covered by health insurance!

When you receive an Explanation of Benefits form ("EOB") from your insurer don't just toss or file it!  Look at it closely.  Your insurer may have denied coverage and then you have a narrow window of opportunity to dispute the denial, following the exact procedures detailed on the EOB.  This often requires obtaining medical records and working in concert with your medical provider to prove the reasonable and necessary nature of the treatment prescribed.  Also, keeping track of the EOB payments allows you to see what your actually out-of-pocket expense is from a particular treatment/date and then allows you to cross-check this amount with the bill you received from the provider.  Occasioanlly the provider will "mistakenly" bill you for a deductible or co-pay amount which is greater than called for by the contract with your health insurer.

In short, dilligence is an absolute must when dealing with medical bills.  Save everything.  Read everything.  Be proactive and do not expect the billers and insurers to "get it right".  If you find yourself unable to pay your bills contact the provider's billing department directly to work out a reduced rate or payment plan.  If a bill is in collections the collectors will almost always accept a payment plan to pay the bill or accept a reduced amount which will satisy the outstanding bill as "paid in full".

Whether health reform will lower medical costs is an open question.  What is sure is that patients will continue to experience difficulty in the arena of medical billing.  Be aware and proactive to avoid the "rabbit hole".

Author: Jarrett J. Northup

About the author: JKFM Attorneys

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