Do you automatically pay your medical bills when they come in the mail?
Do you assume that your provider’s billers are posting the payments and adjustments correctly? Have you ever wondered if you are getting billed for services that were not provided? Do you wonder if you’ve overpaid on services and are due a refund, but not sure how figure it out? Do the EOB’s (explanation-of-benefits) that come from your insurance company confuse you? I have worked in the medical field since 1978 and in the billing aspect since 1994. I am not a certified billing coder, (who may be trying to optimize the highest reimbursement possible from insurance companies for their clients), but I am a consumer who is concerned about the rising cost of healthcare. Every single day patients pay on their statements when no money is due. They just assume because they get a bill that they need to pay it…..no questions asked. Why would you pay for balances that are not your responsibility? As a medical biller, I have made my fair share of mistakes. When I was “learning” to post payments, I didn’t always take the appropriate adjustments when patients had one or more insurances. After both insurances paid, if there was a balance, I just billed the patient. No one double-checked my work. Mr. X called me one day and asked why he still owed money on his deceased wife’s bill. “After all” he stated, “you are contracted with both of her insurance companies. Aren’t you supposed to take the highest adjustments regardless of who was primary and who was secondary?” Sadly, I did not know this answer. I went to my supervisor, who concurred with Mr. X and was told, “yes, take the additional adjustments”. What went from Mr. X initially owing over $300.00 (from the erroneous statement I sent him), changed to owing absolutely nothing. Had Mr. X not questioned his statement, he would have paid money that was not due from him and no one would have known the better. I know I could use an extra $300.00 on something other than medical bills, can you? I’ve also learned to question my own families’ medical bills from early on. When my daughter had a tonsillectomy, I could not believe the exorbitant fees the hospital charged. Not knowing what to look for, I asked for an itemized copy of all the charges. I then took this copy to the doctor that did the surgery. He scrutinized the charges and saw that a surgical pack was billed twice. The charge for each pack was over $400.00! (That was back in the 80’s, now days it would be much higher.) I immediately went over to the hospital billing department and asked them to correct this, plus I insisted that they send a “corrected claim” billing to my insurance company, so they wouldn’t inadvertently pay the duplicate charge in error. Even more recently, my youngest daughter went to the emergency room for an infected ear. I received separate EOB’s from both the facility and the treating physician. Had I not understood what “split billing” was, I would have ran down to the hospital like a raving maniac and asked why they “double-billed” me. I'm in the process of writing an ebook/manuel to help the consumer understand their insurance billing and claims. It's not designed to teach you a crash course in medical coding and billing, but to help you understand the process of what takes place in the insurance billing field, and the tools you can utilize if you feel you are wrongly billed. In the meantime I've decided to post a weekly blog to help people with their billing questions. If you have questions or concerns, feel free to post them on the blog (without giving away your personal information) or email me. I'll try my best to answer your questions as quickly as possible, or direct you to resources that can help as well.
You are absolutely right! Everyone should look at their Medical EOB (Explanation of Benefits) to make sure they are not only being charged for the correct deductible and co-insurance but more important that the doctor, urgent care or hospital is billing for the correct charges...
ReplyDeleteANY medical provider including medical equipment providers can make an error, but unfortunately over charging/charging for services NOT provided is a temptation many medical providers think they can get away with to put some extra cash in their pockets!
Medicare laws state it is Fraud for any provider to write off deductible and /or co-payments unless a patient is eligible for Charity Care. To be eligible for Charity Care a patient must have a very low income and must provide proof via income statements and tax returns.
If you are Medicare patient and your provider is writing off all your balances without having you complete a charity care application along with proof of income he may be committing Medicare fraud.
Same goes for non-Medicare patients. If your doctor is writing off the balance of your account because he says he is a good guy, you better think twice! He or she may be padding your bill for additional reimbursement and writing off your balance so you will not scrutinize the bill.
And this is especially important if you are going to a non-contracted physician or facility and they are telling you they will write off the balance of your bill.
For instance if you go to a contracted doctor or facility you will have lower expense and the medical provider gets a lower reimbursement.
But if you go to a non-contracted facility the doctor may get for example 60% reimbursement on an allowed amount or sometimes even on the total charges and you will be stuck with perhaps an increased deductible and 40% of charges. The insurance company punishes you for going out of network!
The problem is the medical entity has a great opportunity to increase and pad their bills since they will get a percentage reimbursement rather than a lower fixed amount. They will tell you they will accept your insurance company payment as payment in full! And why not they are probably getting double the reimbursement.
Because they are writing off your balance and you are walking away without an expense when the insurance company statement comes you have already been told they will write it off so what do you care what the charges were. Am I right?
Well these medical providers bank on that when they tell you they will write off your balance and that is how they get away with insurance fraud!
Only patients that have to pay their deductible and co-insurance amounts are going to pick apart and complain about medical bills.
You may be unknowingly playing a part in "Insurance Fraud" so be careful. Do not let yourself get caught in insurance fraud! And if your medical insurance finds out you may have to pay every deductible and co-pay you thought you got out of paying!
Check those medical bills and if you do not get an itemized copy of your medical bill ask for one. Every patient has a right to a copy of their medical bill. Even if you do not have any expenses owing.