Over the past few years, increasingly, I hear from patients who (usually after hospitalization) feel that they have been unfairly billed for medical services.They contact me because they find an article or two I’ve written at my Patient Empowerment site at About.com about medical billing and insurance.
When I say increasingly, I mean – since the first of this year the numbers have really spiked. I mean, really spiked. As if the medical billing universe has decided that no one should get a correct bill anymore, and everyone should be required to pay for something they didn’t think they should pay for.
Now – I don’t have the ability to help people get their bills corrected when there really are mistakes. I leave that to the professionals (and yes, of course, I refer almost all those folks who contact me to engage with a billing specialist listed at AdvoConnection.)
However, there are a few general troubleshooting ideas I have for them, like:
- Since insurers seem to change their in-network list of providers on a whim, you must always check to be sure the doctor you’re about to see is still considered in-network (even if he or she has always been in-network before.)
- Likewise with insurance formularies – co-pays, in particular for newly developed drugs, seem to change overnight. Many Tier 3 drugs are now Tier 4 (which, to me, means, let’s just throw out a huge number and charge the patient!) and patients are blindsided by the increased cost.
- Yes, it’s possible your insurance covers most of your hospital stay, but that the anesthesiologist does not accept your insurance – you’ll have to negotiate payment with those who don’t accept your insurance.
- The Affordable Care Act (healthcare reform) does have a list of preventive tests you no longer pay co-pays for, but that doesn’t mean the doctor won’t recommend a test or a drug that will not be covered as “free.” You need to check the list.
- Balance billing is illegal in most states, yet it happens every day. If you think you have been balance billed, then use that term when you call the doctor’s billing department. If they don’t back off the bill, then ask them to explain why it ISN”T a balance bill. And if the answer is not satisfactory, then tell them you plan to report them to CMS. Maybe they’ll change their minds.
Things like that.
So what does this have to do with being a health advocate?
If you are a billing advocate, this is probably your bread and butter – the work you do on behalf of your clients every day. Thank you for that!
But if you another flavor of health advocate, say medical-navigational, then the fact that so many billing problems are occurring, with increasing frequency, provides an opportunity for you to make a real difference for your clients – because you can be the person with the yellow flag. It’s entirely possible that you can save your client enough money to pay for your services – or more.
The key is to provide your client with that “inside information” that medical bills rarely turn out to look like a client expects they will – so what you would like to do on their behalf is to double check all pricing before services are actually delivered.
(Of course, that will be mostly impossible in an emergency situation, but should work just fine in most other situations.)
I would even go so far as to say, that not checking pricing ahead of time could create problems for them – AND you – because if they end up being blindsided on a bill based on something you recommended, and the bill is correct, it will reflect on you – and your client won’t be happy.
I’ve put together a list of good practices, ideas and “how to” links you can use to save money for your clients.
AdvoConnection members: find this list by logging in to your membership dashboard, finding the Client Services Center, then Client Relations. Look for NEW!
Not a member? You can access this list, too – and much more. Join us!
? ? ? ? ? ? LEARN MORE ? ? ? ? ? ?
FOR PATIENTS | FOR ADVOCATES | FOR POTENTIAL ADVOCATES
? ? ? ? ? ? ? ? ? ? ? ?
Our family friend has been struggling with a complex medical diagnosis, and navigating the healthcare system has become overwhelming. They’ve decided to look for a patient health advocate to help them better understand their treatment options and ensure they receive the best care possible. It’ll assure them that health advocates should always verify that the doctor they’re planning to see is still regarded as being in-network because insurers frequently modify their list of doctors that are in-network.