www.advimed.us October 28, 2014 Issue 61
Patient Advocacy: Healthcare on your side
a weekly blog by Martine Brousse,
Healthcare Specialist, Patient Advocate, Certified Mediator
Founder, PRES. AdviMed
Billing Disputes: avoid costly mistakes*
It has become all too commonplace to receive overinflated, incomprehensible, erroneous, unexplained medical bills, sometimes from mystery providers. After all, if all bills were correct and justified, I, and other billing advocates would be checking job posts.
The usual reactions are discarding the statement as a mistake, placing it on the to-do list (or is it the never-to-do pile?), waiting for a miracle, appealing the insurance, getting upset at the phone representative or asking nicely for an explanation or a discount which may never come.
Before you give up, or worse before your account goes to collection, consider these steps.
1. Use your right to question
Medical providers are considered, under state and federal consumer laws, in the same category as other purveyors of services. It is your right to ask for justification and explanation of a statement, or proof services were rendered.
Just as you inquire about a charge on your credit card statement, or an item on the store receipt, so can you for medical bills.
2. Contest in writing
You should contest a balance or request clarification in writing. Address your complaint to the office manager, billing manager or physician. Knowing the name and contact information for the person in charge often translates into prompter responses and better outcomes.
Confirm with the billing department, preferably in writing, that your account is on hold and will not be reported to a collection agency until this grievance has been addressed, as per the Fair Debt Collection Practices Act.
Specific insurance appeal forms are usually required. These can be found on the website.
Sending your documents certified mail, or via any way that can confirm its receipt, is best.
3. Share the news
If your grievance is with your insurance company, you must inform the interested parties of any delay in payment on your part. You may ask a representative to contact the billing department and request for your account to be placed on hold, as it is not done automatically. This step should be in addition to your written notice.
If a medical provider uses an outside billing service, both offices must be contacted. Communication between both parties is all too often infrequent. Avoid costly misunderstandings by mailing two letters.
4. Keep the account current
While the insurance works hard at finding ways to deny your appeal, or when waiting for the facility to mail you an itemized bill or review the charges, you must make small monthly payments to keep your account current. Sending a small monthly remittance shows good faith, confirms your acknowledgement of the outstanding balance, and buys you time.
Remember that it is much harder to get a bill reduced once it is in collection. Unless you have confirmation that your account has been placed on hold (and the date it expires), the countdown is on.
5. Give updates
Billing people love hearing from patients with unpaid balances (trust me, I know!). It reassures them that you are neither a deadbeat nor trying to pull a fast one. Regular updates will prompt more understanding and patience on their part.
6. Keep good notes
From the first call on, keep a log of calls made and received, the content of the discussion and subsequent results. Keep a copy of every written correspondence as well. Some providers are more eager to use the collection tool, and this evidence will work in your favor. Insurers keep notes one every call or letter you make, so should you.
This documentation may also come in handy if you are forced to go up the corporate ladder, need to escalate the issue or eventually file a grievance with a government agency.
Delaying may end up costing you dearly. Other bills may wait without harmful consequences; medical statements should preferably be looked at promptly.
Timeliness may also become an issue if you decide to file an appeal with your insurance, as a deadline of 90 days is usually the norm. Check the website or your policy for more details.
Nobody likes to wait to get paid when the job is done, and your doctor or hospital are no different. Prompt, precise and courteous communications will be appreciated.
* Previously seen on NerdWallet
©  AdviMed.
©  Martine G. Brousse.
All rights reserved.
My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.
Quote of the week
"If you want to go fast, go alone. If you want to go far, go together" African proverb
AdviMed (424) 999 4705 or (877) 658 9446 fax (424) 226 1330