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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 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 a response 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 show good faith. If you need clarification, make your call early. If you disagree, do so in writing as soon as possible.
Insurance companies have time limits for policyholders filing a first grievance or second-degree appeal. Ninety days from the date on the Explanation of Benefits (EOB) form 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 misunderstandings and wasted effort.
It is of the utmost importance to follow the policy guidelines about filing written appeals. You usually only have two chances — use them well. A phone call asking for an explanation may count as strike one if you are unclear with the representative about your intention.
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. The Internal Revenue Service is also interested in this information. Keeping accurate records will prove worthwhile when filing for medical expense tax credits or seeking reimbursement from your health savings account (HSA).
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 appear quickly.
An Excel spreadsheet is a great tool for tracking statements, EOBs and amounts paid. Keeping it updated weekly or monthly takes little effort and can bring great reward. This is the way I keep track for my clients, and I strongly recommend it as a managing tool.
4. Details count
Small details make the difference between success and wasting time and money on losing efforts. Winning an appeal may well depend on reporting or explaining your circumstances.
Some examples: An error on the hospital’s part caused you to have to stay longer. Your provider was in-network but canceled his contract with your insurance in middle of treatment. You 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 your doctor needed the results as soon as possible.
Managing medical bills, establishing the best course of action and getting the best outcome depend on basic organizational 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 a growing pile until you can get to it — is neither cost-efficient nor advisable.