The Patient Advocate Foundation -- tulsaworld.com/PatientAdvocate -- a nonprofit that helps patients through the medical insurance maze, says you should never assume "all bills are final" or that you are about to be "turned over to collection." Hospitals don't give up on their full payment without a good deal of patience (with their patients).
Wait 30 days: Your bill for polyp removal arrives from your doctor when you were expecting your health insurance plan to cover it, as usual. It could be your doctor's billing cycle is ahead of your insurance company's claims processors. Waiting a few more days might do the trick. Medical provider bills come with billing time-lapse graphs: 30, 60 and 90 days. When you see the "patient owes" amount in the "90 days" box, you're about to be turned over. Call the insurance company and report your findings to the provider.
Pair bills with EOBs: You have a pile of insurance plan "explanation of benefits" (EOBs) statements and medical bills, and it's hard to tell what or whom you owe. Staple medical provider bills to the EOBs paired by "dates of service" in a folder. When phoning medical providers or insurance companies with payment questions, write on the bills or EOBs the dates, whom you spoke to and the issues resolved.
Incorrect procedure code: An insurance claim that is usually paid comes back stamped "denied." This could be due to the provider putting the wrong medical service code on the statement. Call the insurer, ask what the proper coding is and make sure the code matches the service you received. Most group policies pay for an annual physical, but the claim is denied if providers list exam components individually. Ask the provider's office billing agent to list the physical as "annual wellness exam" on the claim.
In-network only: Always use your group plan's "in-network providers" to keep down out-of-pocket costs. In-network providers have agreed to accept a percentage of what they usually are paid, and the group members pay the difference. Out-of-network providers don't have to write off that difference, so you wind up paying more as you are stuck paying the full amount when your group plan rejects the out-of-network bill.
Check provider treatment codes: When your insurer denies your pre-approval request for a potentially life-saving treatment, instead insisting you use a standard treatment, or deems the proposed treatment experimental or investigative, check the new treatment's provider code. It could be too new for the plan's computer system to recognize. If the treatment still has not been classified as customary, ask your physician to write an appeal letter explaining why the treatment is necessary. There are several levels of appeal, and if it's a life-or-death situation, the insurance company must respond in 24 to 72 hours. For other situations, the time frame ranges from 30 to 180 days, under state and federal law.
See Also:
[widget:related_reads__best_of]
Don't Assume All Medical Bills are FinalOriginally from: http://www.nursinglink.monster.com/news/articles/12823-dont-assume-all-medical-bills-are-final
View this post on my blog: http://travelnursesuccess.com/dont-assume-all-medical-bills-are-final-2
No comments:
Post a Comment