www.advimed.us October 21, 2014 Issue 60
Patient Advocacy: Healthcare on your side
a weekly blog by Martine Brousse,
Healthcare Specialist, Patient Advocate, Certified Mediator
Founder, PRES. AdviMed
A few Tips about
Medical Bills Management*
I am often asked about how best to manage mounting medical bills. This is often due to the difficulty many patients experience when facing serious health issues, managing appointments and maintaining their daily activities. Who has the energy and will to deal with financial paperwork under such circumstances? Who has the time to call medical providers and insurance carriers? How do you negotiate a bill or even know for sure that a statement is correct?
While patient advocates specializing in billing matters or accountants can assist in this task, they can only do so based on the documentation they receive. Here are some tips that may make a difference for you and for them.
1. Be mindful of time limits
Patients usually have 30 days to make a payment on their account, or inform the office of their intention to contest a balance. Delaying may mean collection action (sometimes in as little as 60 days), or paying added interest. If you need more time, make a small payment to keep the account current and to show good faith. If you need clarification, make your call early. If you disagree, indicate so in writing as soon as possible.
Insurance companies place time limits on policyholders filing a first grievance or second-degree appeal. Ninety days from the date on the Explanation of Benefit ("EOB") or the determination letter are the norm.
Remember to report any arrangement, payment plan or settlement you have in place to your advocate to avoid misunderstanding and wasted efforts.
It is of the utmost importance to follow the policy guidelines about filing written appeals. You usually only have two: use them well!
A phone call asking for an explanation may count as strike one, even if you are unclear with the representative about your intention. Asking the adjuster to reprocess the claim "because the insurance did not pay enough" is a sure denial in the making.
3. Play the matching game
Your advocate, accountant or family member handling the bill are not the only ones looking for correct information and exact figures, so does the IRS. Keeping accurate records will prove worthwhile when filing for medical expenses tax credits or seeking reimbursement from your HSA account.
I recommend matching every statement from providers with the corresponding insurance EOB. This will allow you to verify that the amounts billed to you are justified, and that every medical service has been submitted to your insurer for payment. Discrepancies, errors or issues should soon become apparent.
Using an Excel spreadsheet is a great tool to keep track of statements, EOBs and amounts paid. Keeping it updated on a weekly or monthly basis costs little effort, with great reward. This is the way I keep track for my clients, and strongly recommend it as a managing tool. You need to itemize every charge, but each date of service and provider should have an entry.
4. Details count
Small details make the difference success and wasting time and $ on losing efforts. Winning an appeal may well depend on their reporting or explaining.
Some examples: an error on the hospital's part caused you to have to stay longer; the provider was in network but canceled his contract with your insurance in middle of treatment; the patient signed a financial agreement while still under the influence of anesthesia or without an interpreter; the office sent your samples to an out of network lab because the Dr needed the results ASAP.
All of these are routine denials, yet each one can be the reason for winning your appeal.
Managing medical bills, establishing the best course of action and getting to the best outcome depend on basic matching and minimum organization skills. While hiring a billing advocate can mean peace of mind, not every patient can afford this service.
A small investment of time can save you money by recognizing errors, missteps or even fraud and having them reversed.
Blindly paying every bill you receive, or sticking them on the growing pile until you can (or want to) get to it are neither cost-efficient nor advisable.
* 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
"It always seems impossible until it is done" N. Mandela
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