WHAT YOU NEED TO KNOW ABOUT MEDICAL BILLING
I love blogging, but to be honest I also work full-time in the medical field as an Account Analyst, which is just a fancy term for medical billing. I do not always love my job but I have learned a lot over the years, gaining a lot of knowledge from my years in the medical field.
I started out when I was in high school in dietary at a small Catholic nursing home and was quickly promoted to become a nursing assistant. The rest has been pretty much a series of various medical related jobs within a large healthcare corporation where I have been for the past 15+ years. I graduated college with a degree in business management and because of the great benefits with my company, I chose to remain in my profession.
After years as a nursing assistant and also as a medical assistant in a Physician's office, I was blessed to receive some on the job billing experience. I began my career as a medical billing specialist and my eyes have truly been opened to so many things that I never knew as the average person about medical billing. I believe these things need to be shared and so I am writing this post today to hopefully make that difference in someone's life. Your financial future can be impacted dramatically by these things, if you are not aware of them and if you do not know how to handle them.
I have also written another previous post related to this same subject you may find helpful as well when attempting to understand your medical bills. You could save money on your medical billsThese are the top things I wish as a medical billing specialist that people knew because they could potentially save them a lot of money on their medical bills. This could also prevent a lot of what may be mistaken as harassing phone calls from their providers.
1) Always make sure to provide correct information for billing.....
When you visit a hospital or medical facility you must provide accurate information for billing purposes. This can include anything from correct and accurate address and phone number for you to be reached at, The correct information for the person the In insurance is under ( In medical terms we call this the guarantor) updated insurance cards and make sure we have all of your Insurance cards. The reason that I say these things may not be obvious to the average person or some may even mistakenly believe this may help them not receive a bill. Did you know though that inaccurate information can leave you being billed for an entire balance at times. If your provider does not have an accurate address and phone number, you may not know until it affects your credit negatively. I tell you this to help you because I see this often in my profession, we as medical billing specialists never want this to be the end result. Without this information however protocols often dictate dropping the complete balance to a patient responsibility if we are unable to obtain this info and do not receive patient contact.
2) If you have a baby make sure they have been accurately and quickly added to your plan....
Many people do not realize there is a process that must be done to add a baby to their Insurance plan. Make sure you keep in contact with your Insurance company, your human resources department if it is through your job and also the hospital billing department at the hospital to make sure this runs smoothly. Also be especially careful if you give birth to twins that they accurately add both twins to the coverage and that each billing statement you receive is correct for your twins. We have a lot of issues with billing for twins and you want to make sure both are added and you are not inaccurately billed for services due to twin billing issues.
3) Always verify that medical procedures are covered under your plan....
If you are having a procedure done always make sure you find out first if it is covered by your insurance. Anything that could potentially be deemed experimental, cosmetic or unauthorized can become your responsibility depending on your insurance so always make sure it is covered by your plan.
4) Accidents or Injuries are not always covered by your Insurance.....
Understand that any way your medical Insurance carrier can find a billing loop-hole they will often explore it. If you have visited an ER or been admitted for an Injury there will most likely be an Investigation by the Insurance company and they may deem that they are not responsible. If the accident or Injury can be at all determined to be related to an auto accident, a workplace injury or in special situations an injury at a business or even in your own home may be deemed not their responsibility. If it is related to an Injury or can even look like an Injury to the Insurance company be prepared and aware, if you receive any communication related to this you are required to respond or this balance will become your responsibility as well.
5) If the Insurance company says the Illness cannot be a preexisting condition believe them.....
You may not believe there is a way for them to find out that this was previously diagnosed but honestly they can. When an insurance company suspects this they will begin an investigation and medical records will need to be released to the. If you do not comply then they will bill you and if you comply and they find it is true you will be billed. Either way it will be discovered and you lose financially.
6) Make sure your Information with the Insurance company is accurate.....
An error in your name, sex or date of birth can be huge. In fact the smallest difference such as the Insurance company listing you as Dave instead of David can cause your claims to deny. What will often happen in these situations is the Insurance company will deny your claims stating you have no active coverage and you will be billed if the facility cannot get in contact with you.
7) Check your Explanation of benefits.....
The name I just referenced here may make no sense to you because most people do not recognize this term. Let me explain the Explanation of benefits or EOB is a form you will receive in the mail prior to your bills from the hospital. This is what generates when your claim processes or denies and will go to both the facility that billed you and also to you as the patient. The EOB is actually very helpful because it outlines what was billed and what your responsibility is as the patient after the Insurance has processed. My advice is look at it and understand that we as billing staff are people and we can make errors when billing you and so can software programs so make sure what you are billed is accurate according to that document. If you have any questions be sure to call the number on your statement, no question is a dumb question when it comes to your bill. You may find that one phone call you make can save you significantly if an error has been made o it can help you understand for further situations why you are being billed that amount.
8) Coinsurance, copays, deductible.......
All of the terms referenced here are terms that are related to a patient responsibility for services provided determined by your Insurance company. In short there are lump sums that must be paid out-of-pocket before anything is covered by the Insurance or percentages charged to the patient that must be collected for any care a patient has. Your Insurance company determines this and outlines this for you in your paper work provided to you upon signing up. Some insurance companies may require you to access this information regarding you plan on their website and this may be where you would locate your policy benefits guidelines. Find out what the fine print states for your coverage and make sure you understand what your responsibilities are as a patient.I really hope that you find this information helpful. I am not a lawyer so I cannot provide legal advice, but I can advise you that you should be on top of all of these things and be honest and diligent in all these situations. It will only help you out in the end and can save you thousands of dollars and significant stress and heartache.