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Navigating the Frustrations of Medical Billing

Navigating the Frustrations of Medical Billing

Going to the doctor’s office to be treated for a certain physical pain shouldn’t also be a financial pain. 

To ease the worry of getting doctor bills, below are a few steps that will help you to confidently open those dreaded bills.

Know Your Benefits

The most important part of the insurance puzzle is to know your benefits and what is covered by your insurance company. Prior to making an appointment, know if you need a referral to see that physician. Also find out whether the provider is in network – by making a phone call to the insurance carrier, NOT the doctor’s office. The calls to the carrier are recorded so you can jot down to whom you spoke, time, etc. for your own backup. Also, just because the doctor says that they will “take” your insurance, doesn’t necessarily meant that they are in network.  You could be billed and subsequently responsible for out-of-network charges.

Your insurance carrier should provide you with a Summary of Benefits Coverage document which will show you what you can anticipate for the office visits. Is your copay $30? $40? If the physician needs to order additional testing (labs, CT scans, etc.), you will probably pay additional copays, coinsurance or deductibles for these services as well.

Just because you receive an invoice from the physician does not mean that is what is owed. The doctor’s office will bill the insurance company, but sometimes only AFTER the invoices are sent to you. Look to your Explanation of Benefits from your insurance carrier that will show what was submitted and what your copay, deductibles and out-of-pocket costs should be.

Types of Doctor’s Visits

Not everything is a preventative visit. For instance, if you take a high blood pressure medication as a preventative to possible heart issues, a visit for a medication check is not considered preventative. Also be aware that if you want to have your annual physical and end up discussing your medications, hurt finger, etc. – you will likely pay for that visit as a diagnostic. Need to know what is considered preventive?  Here’s a link: https://www.healthcare.gov/coverage/preventive-care-benefits/

Please understand that everyone makes mistakes – sometimes the coding on your invoice shows a procedure which was not performed or simply miscoded. You can look at billing codes from your provider by going to: www.findacode.com. Don’t be afraid to ask for an itemized bill. After all, if your car needed service, you would not only get an itemized bill, but know exactly what you are paying for. Also, make sure that the payments you made to the provider are actually coded to your account. Not to name names, but my (it rhymes with “busband”) went to the doctor and was not only over-charged but the payment that was made went toward someone else’s account. The invoice that was received would have been double-paid, but because we caught the error, we now have a check coming back to us (I call this “shoe money”).

Prescription Prices

prescription drugs

Most physicians are spot-on with their billing and procedures. This is just a guide to help you to take control of your health, benefits and prescriptions. Speaking of prescriptions – it is always a good idea to shop around for the best rates. Although I do not recommend using multiple pharmacies (due to complications for drug interactions)…here is a link to compare prices:  www.goodrx.com  

Lastly – rely on your broker to help you to understand your benefits and responsibilities… and since I gave you so many links to check out – here’s the BEST one:  www.aandhinsurance.com

Grace Daidone Grace Daidone is a Health and Benefits Consultant for A and H Insurance. She specializes in small group, individual and Medicare health benefits insurance.

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