Having Trouble Deciphering Your Medical Bills?

August 27, 2013
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As you may already know from experience, deciphering medical bills can be a difficult task. People often pay these bills without knowing exactly what they are paying for. If you find yourself in this situation, you may want to consider hiring an insurance advocate.

MedWise Insurance Advocacy describes their service as delivering “financial solutions by providing patients and their families as well as attorneys with an experienced insurance liaison to sort through and resolve their mounds of medical bills, lien claims, insurance pre-authorizations, denied medical insurance claims, medical letters of appeal, understanding explanation of benefits and advocate for patients or legal clients regarding any insurance issues that arise or require expert attention.” If there is any confusion about exactly what you are paying for or if you feel that you are paying too much, it may be helpful for you to speak with an expert in the field.

MedWise Insurance Advocacy also advises hospital patients to use the following 10 Techniques to Prevent Staggering Hospital Overcharges:

1. If your hospitalization isn’t for an emergency, check your insurance policy to find out just what it will cover and how much it will pay. Be sure to carefully review the section on “exceptions and exclusions.” It will tell you what your plan will not cover.
2. Phone the hospital’s billing department and ask them what you will be charged for the room, and just what the room charges cover. If tissues aren’t included, for example, bring your own.
3. Ask your doctor to estimate your cost of treatment. Also, ask if you can bring your regular prescriptions from home to avoid paying for medications administered at the hospital.
4. Make sure that everyone who will be treating you – the surgeon, anesthesiologist, radiologist, pathologist, etc. – participates in your insurance plan.
5. If you can, keep your own log of tests, medications, and treatments. If you are not able to, ask a friend or loved one to do it for you.
6. At some point, you will receive an explanation of the benefits (EOB) from your insurance company (if you’re on Medicare, you will receive a summary notice). It will say, “This is not a bill.” Don’t toss it in the trash. Examine it. It will tell you how much the hospital is charging, what your insurance plan will cover, and what you will have to pay out of your own pocket in deductibles and co-payments.
7. Never pay your bill before leaving the hospital – even if you’re told that it’s required.
8. When you get your bill, read it carefully. Compare it to the log you made, to the EOB, and to the estimate of costs you requested before you were admitted.
9. If there are any items you don’t understand, call the billing department and your insurer, and ask them to explain. Don’t accept bills that use terms like “lab fees,” or “miscellaneous fees.” Demand an itemization. If you don’t get satisfaction from the hospital billing department – and you probably won’t – appeal in writing to the hospital administrator or patient ombudsman.
10. If you are still scratching your head, ask for an itemized bill as well as your medical records to confirm whether you received the treatments and medications you’ve been billed for. Every state now requires hospitals to provide itemized bills.

MedWise Insurance Advocacy is owned and managed by Adria Gross, a New York State-licensed insurance broker and consultant with over 20 years’ experience in the health insurance industry. A free consultation can be obtained by calling 845-238-2532 or via e-mail: adria@medwisebilling.com

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