You get closer to financial freedom when you effectively find and get rid of incorrect expenses. Most people get their medical bills and/or insurance statements and promptly file (or throw) them away. By carefully reviewing these statements, you may notice several mistakes in medical charges and by being diligent in following up on these mistakes, you can avoid paying lots of extra unnecessary costs. This is very easy to do.
When you receive a bill from a doctor’s office or an insurance statement, it is very easy to assume the bill is accurate. Often, there is a small mistake that can lead to an extra cost. I don’t think there is any maliciousness involved on the part of doctors or insurance companies. In almost all cases, both the doctor’s office and insurance companies are very helpful in resolving these issues. Here are some examples. Please keep in mind there are circumstances where these examples may not hold true.
Primary Physician – Even though a primary care physician is selected for your doctor, it may not be coded accurately with the insurance company. Therefore, you pay the correct co-pay for an appointment, only to receive bills for additional money due for each visit. A quick call to the insurance company will help resolve this issue by ensuring the correct physician was selected as the primary care physician. At the same time, confirm with the insurance company that you no longer owe the additional money. Once resolved with the insurance company, contact the doctor’s office to inform them the correction was made and you no longer owe this money. This type of issue, once resolved, will typically not happen again.
Billing System Errors – This one is a little more complicated. You go to your primary care physician and as part of your wellness checkup there is a test you do on a regular basis. According to your plan this test is supposed to be covered as part of the wellness visit, but a month or two later you receive a bill for a small amount. What may have happened is the doctor may have mistakenly charged more than the contracted amount. The contracted amount is the amount the insurance company will pay to the doctor for a given test or procedure. Typically, the doctor should not charge more than the contracted amount. However, if the doctor has different contracts with different companies the contracted amount can vary and/or mistakes can be made.
If the doctor charged more than the contracted amount, the insurance company will only pay the contracted amount. When the insurance company’s payment is credited to the doctor’s billing system, if the contracted amount is less than the doctor submitted to the insurance company, the billing system is often programmed to charge you the difference – and you get a bill. Call the insurance company to confirm you do not owe the additional money. If in fact you do not owe the balance, contact the doctor’s office to let them know. As it may be a programming error, it may recur and you will need to go through this process each time.
Inquire About Costs Beforehand – If you are going to take a particular test, contact your insurance company upfront so you know what they will pay for and what you will be responsible for. Make sure you know (or ask) about your deductible and how much has already been paid. If you have not yet met the deductible, you may be responsible for additional costs. Knowing beforehand will help you decide whether you need to go forward with a particular test.
Document Conversations – Sometimes a doctor’s office will contact your insurance company on your behalf to check that a medical test or procedure is covered. They do this to protect themselves but it can also protect you. If your doctor’s office tells you that it is covered by your insurance company, write down the name of the person who told you this. Sometimes even if the office says it is covered, you may still receive a bill from the facility where the procedure took place. This can happen because the billing person who is submitting the information after the procedure may not be using the same procedure code that was used when the procedure was originally cleared by the insurance company. When this happens, you will need to contact the doctor’s office and speak to the person who made the original call to insurance company to confirm it was covered. Most medical practices stand by their statements when they have spoken to an insurance company and will often follow up for you to make sure the correct procedure code was used when the office submitted the bill to the insurance company.
These were just a few examples of how to check medical bills and insurance statements. I am sure there are many other ways these bills/statements can be checked. Please note that there are many different reasons why charges can happen and they are not always mistakes. There will still be times when you need to pay these charges. However, by being diligent in checking, you can ensure you are only paying for the amounts you are obligated to pay for.
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