Medical billing errors, including those on hospital bills, can quickly become a nightmare for both caregivers and their loved ones, if you don't stay on top of them. The longer an error goes uncorrected, the less likely it is that you will be able to successfully fix it.
Hospitals, physicians, and other providers are likely to send your account to collections if it is not paid within five to six months. While each entity follows its own guidelines with regards to how quickly it considers an account to be delinquent, most expect your bill to be paid in full unless other arrangements have been agreed to within ninety days of the date of service or forty-five days of when Medicare or your insurance plan has processed the claim.
Failing to pay your medical bills is very likely going to affect your credit, and unpaid hospital bills are a major reason why people file for personal bankruptcy.
It is particularly critical that you stay on top of billing errors. This is because there is something known as "timely filing" in the insurance business. The regulations for Medicare and the plan documents of you supplemental insurance must indicate how long you or your provider has to submit claims.
Once that time has passed, it is permissible for Medicare or the insurance company to deny your claim because it wasn't submitted within the required time period. At this point, the entire bill becomes your responsibility.
Similarly, if you don't agree with how your claim has been processed, you have a finite period of time to appeal the decision and escalate it through Medicare, or the insurance plan's dispute resolution process. If you miss the appeal deadlines, you're usually out of luck.
Many different kinds of medical billing errors are possible, so you must have an eagle eye when you read your parents medical insurance bills, or your own.
Perhaps the simplest error for a layperson to find is a charge for a service that was never provided. For example, if you were billed for a test that you never took, make sure to dispute it. The fact that the clinician ordered the test and marked it on the "superbill" at the time of the visit is irrelevant if the lab never performed the test and recorded the results.
Your medical record is the governing document when it comes to these disputes. If it's not in the records, it shouldn't be billed.
Another common mistake on health insurance claims and billing is duplicate charges where the provider has billed you for the same service more than once on the same day. While this makes sense sometimes, such as when you have an x-ray of both your right foot and your left foot, the provider needs to use a special code called a modifier to explain this to Medicare or the insurance company.
Also, keep watch for charges for things that the hospital or doctor isn't supposed to bill for separately. For example, if you have had surgery, the follow-up care should be included in the "global fee" for that service. For major procedures, that means that you shouldn't be charged for a follow-up visit within ninety days of the date of the surgery. You can, however, be charged for additional services other than the office visit itself, such as an x-ray or cast. Similarly, if you are hospitalized, the hospital shouldn't charge separately for sheets for your bed or your hospital gown, both of which are included in the room-and-board charge.
But, even when you do everything suggested above, there will be times when you don't agree with a provider's bill, or how Medicare or your insurance plan has processed the claim.
Medical billing advocates can save time, money and effort
If you don't have the time (or the tolerance) to handle your medical bills and related insurance claims yourself, professionals are available to assist you.
Medical bill advocates are there to take care of these issues for you and can spot and avoid medical billing errors. You can choose to have such an advocate review all of your medical bills, or engage one only to assist with sorting out a difficult issue.
Many states offer free assistance via the SHINE (Serving Health Insurance Needs of Elders) program. Check with the bureau that handles elder affairs for your state.
Medical billing advocates not only help individuals review medical bills for errors and act as medical bill analysts, they also make sure what you are being asked to pay is something that you actually owe, that you are not being overbilled, and that Medicare or your insurance company is paying the amount it is obligated to pay. They go over your bills and your coverage with a fine-tooth comb and make sure you get the benefits for which you are paying and to which you are entitled.
According to the Medical Billing Advocates of America, up to 90% of hospital bills have errors, and those errors are not in your favor.
Most people do not ask for and do not receive an itemized statement showing what they are being charged for. If you went to the grocery store and they handed you a receipt that said, "Produce $40, meat $100, and canned goods $50, total $190," you probably wouldn't accept it. You shouldn't accept bills lacking in detail from medical providers, either.
So, having established the efficacy of hiring a medical billing advocate, where do you find one?
As with most professional services, the best way is through word-of-mouth. Patients who have had a positive experience are happy to share their story.
You may also visit the website for the Medical Billing Advocates of America, for a list of medical billing advocates. Since most medical billing advocates' work is done by telephone and email, it isn't necessary to hire someone who lives near you. It's best to hire someone who has a background in health care, insurance, or related fields.
Medical billing advocates are usually paid in one of two ways: Hourly for the time actually spent on your case, or a percentage of the money the advocate saves you off your medical bill. In this latter case, if an advocate can't secure you a reduction in the medical bill you owe, you should be required to pay only the advocate's retainer (if any) and the costs of obtaining copies of your medical records. Discuss with the medical billing advocate which of these payment methods he or she employs, and then get, in writing, the terms and conditions of their contract with you.
Also, as with every service provider, check out the advocate's references before hiring them.