Commentary by Kari Berger
After a recent visit to the doctor’s office, a bill arrives in the mail for several hundred dollars. What went wrong with the insurance? Administrative errors can bring patients unnecessary invoices that are easily corrected.
Insurance companies send out an explanation of benefits before the bill comes. Save this document at least four months in case the provider bills for a service that insurance already paid in full.
Sometimes, a bill will arrive that never passed across an insurance company’s desk. This mistake occurs when providers use a separate laboratory that doesn’t have insurance information on file. The lab believes the patient is paying for the test. Call the lab’s billing office and ask if there is any insurance policy listed on the account. Provide the insurance policy number and ask the lab to re-submit the claim.
If insurance denied payment, ask for the denial reason. An insurance company may believe their own policy is secondary to another policy, especially if a patient has recently lost coverage from an employer and uses Medicare or a spouse’s insurance. Call the insurance company and update the coordination of benefits, which establishes the order that insurance policies will pay on claims, e.g. union policy pays first, and Medicare pays the remainder.
There may still be a charge after the claim is processed by insurance. It is always in the provider’s best interest to work with patients rather than pay a collections agency to go after the money. Many hospitals have financial assistance for patients, who usually provide proof of income and assets. Billing offices can create a budget-friendly payment plan. Regular payments protect credit scores and keep away collections agencies.
Always ask if the provider is in-network before scheduling an appointment. Before having a procedure done, ask for a quote to limit post-visit surprises. Understand the insurance policy’s benefits and know how much money may ultimately be the patient’s responsibility in a calendar year. Provide updated insurance information to doctors and specialists.
A few common-sense precautions will make medical bills less unexpected.
Kari Berger is a Carmel resident and health care administrator.
