Unfortunately, elders and their families make some common mistakes regarding medical billing…mistakes that can cost them thousands of dollars. Here are the top five mistakes people make when dealing with medical bills.
Mistake #1: Ignoring the mail
Why is it that so many of us receive mail from a medical provider or insurance company and put it in the "I'll get to it later" pile on the kitchen counter, often unopened? The most common reasons are:
- The paperwork intimidates me
- I don't understand what I'm looking at
- I have insurance, so I don't need to review this stuff
- I can't pay it anyway, so why open it and stress out about it?
The reality is that taking this approach is very likely to come back to haunt you in the form of being sent to collections. If you don't understand the bills or explanations of benefits (EOBs) you receive following a medical service, ask someone to explain them to you. You can call the patient billing specialist at your provider or try the customer service representative for your insurance plan. If necessary, you can enlist a medical billing advocate to help.
Everyone needs to review their medical bills and how the claims were processed, even if you believe that you have "good" insurance or Medicare and a supplement. Billing mistakes can and do happen, and you, the patient, are often responsible for paying for them. While you have the right to appeal, you must do so within the timeframe required by your plan. By ignoring the mail, you risk missing this important appeal deadline. If you're worried that you can't pay what you owe, you're always better off to negotiate a payment plan and possibly a reduced charge than to simply ignore the demands for payment and end up damaging your credit.
Mistake #2: Not asking for (and then reviewing) itemized statements
The best way to avoid medical bill problems is to make sure that the charges are correct in the first place. While no one expects you to be an expert in medical terminology, by requesting and reviewing a detailed itemized statement following every episode of care, you can often avoid some of the obvious problems. Always take the time to ask for and look at an itemized bill. If you see something that doesn't make sense, try to get it resolved immediately. If you feel you are being charged for services you did not receive, ask for a copy of your medical record.
Mistake #3: Not asking for what you need
Many insurance plans limit the amount of services you are eligible for. For example, physical therapy visits are often limited to a certain number within a period of time. While this works out okay in many instances, sometimes a patient just needs more sessions in order to optimize her recovery. When that happens, asking your physical therapist or physician to write a "letter of medical necessity" IN ADVANCE of the provision of services. Don't wait until you've run out of visits before you ask your providers to help advocate for you. It's your responsibility to be aware of the limits on your policy and not to just assume that your providers are on top of it.
In other situations, doctors will prescribe a certain drug, not realizing that a particular patient's plan only covers a less expensive alternative. There is no way that a physician can keep track of the frequently changing approved drug lists for each of her patients, so if you, the patient, go to fill the prescription and found out that the drug your doctor prescribed is not covered, it is perfectly reasonable to let your doctor know and find out whether something that is on the list will be a reasonable alternative. If your doctor feels very strongly that you need the specific drug, don't hesitate to request that the doctor's office make a phone call or prepare a letter of medical necessity. He may not succeed, but if you don't ask, you definitely won't get the intended medication.