Navigating the health care system can be tricky and intimidating. Understanding your insurance benefits, how they work, what provider you are allowed to see and how much it will cost can be overwhelming. Coupled with this, 67 percent of all medical claims have some error that usually favors the insurance carrier and not the patient, according to data from AR Rescue that looked at 127 clinics and 1.6 million individual claims in Nevada, Arizona, Indiana and Texas. These can present challenges at a time when a person wants to focus on rest and recovery, not paperwork and processing.
AR Rescue provides billing help for medical offices. Over the course of time, the company identified some of the common billing situations — from modest errors to exorbitant bills — that consumers encounter.
Know your deductible: Check your insurance paperwork to be familiar with your deductibles and how they are to be collected.
It’s a common practice for offices to ask for payment upfront; this payment would likely go toward your deductible. If you are faced with a medical situation that requires a number of different specialists, all of those upfront payments will accrue. This is a common practice and many times puts a financial strain on the patient. Many commercial health plans no longer allow this practice and with good reason.
By the time your bills are processed by the insurance company, it may determine you only owe one office any money from your deductible — it’s good news, financially, but you now have the painstaking process of trying to figure out how much money should be refunded to you and by whom.
To further complicate matters, practices may not refund the money until the insurance company has completely settled their bill.
Knowing your deductibles will help you ensure that this situation doesn’t arise; contact your insurance company if it does.
Medicare patients and non-covered services: Medicare is a robust engine that drives what other insurance companies pay. One common error involves the Advanced Beneficiary Notice. An ABN is simply a form that a physician’s office must get signed from a patient. It acknowledges that a specific service or procedure will probably not be covered by Medicare and the patient agrees to the out-of-pocket costs (that may not be covered by insurance). The ABN must be signed each and every time a patient has a service done that will more than likely be denied by Medicare. If this form is not signed by the patient and the service is denied by Medicare, the provider cannot bill the patient for that service. This is by far one of the most common situations we see when Medicare patients are sent to collections.
Asking for a reduced bill: A practice cannot waive copays. That’s a direct violation of almost every insurance contract and can cause the provider to lose the contract. You can ask for an overall reduction in your bill. The doctor doesn’t have to comply, but a request made kindly can turn into savings.
Hardship writeoff: A little-known assistance program is a hardship writeoff. This can reduce or completely waive a patient’s balance. This is a debt-forgiveness program; forms range from simple one-page requests to multipage applications requiring extensive financial explanation and documentation. The silver lining is that in most hardship requests AR Rescue has seen, an approval for either a partial or full forgiveness of the bill has been arranged.
Settle your account: If your problem is a large bill, you may be able to request a settlement agreement. With a settlement agreement, the facility or physician takes a greatly reduced payment up front and writes off (forgives) the remainder of the debt. This not only works for old health care bills but can be used when negotiating an up-front cost for a procedure. This step could affect your credit score, depending on if your bill has been sent to collections.
Collection accounts: One great driver for bankruptcy are health care bills that find their way to a collection agency. Most people only discover this when they go to apply for a mortgage or vehicle loan and see their credit score. We have found that about half of these were assigned in error.
If a patient discovers a medical bill is in collections, the patient should immediately call and send in a certified letter with return receipt to the collection agency formally notifying them this bill is in dispute. This allows a 30-day window to resolve this without it being reported on the patient’s credit report. If it is already on the credit report and can be proved it was not the patient’s liability, the collection agency must remove it from the report as a deletion, so it will be as if it never happened.