A few months ago one of the Patient Leader groups that I’m a part of, asked a simple question. It seemed like a simple one. Had we ever come across any mistakes on our medical bills? To a lot of people, the answer probably was no, or what are you talking about?
When the Explanation of Benefits comes from your insurance, do you look at it? Do you compare what the medical facility charged, what was reimbursed by your insurance coverage and what your copay or deductible are? Many of us don’t give it a second thought. We figure that if we got a bill, then it must be correct.
You’ve been thinking wrong for far too long. It’s time to start going through everything with a fine-tooth comb. Absolutely, 110% KNOW WHAT YOUR INSURANCE PAYS! This is imperative, also track your deductible and out-of-pocket maximum for each year. Many, like my husband, only go to the doctor once a year. Those of us with chronic illnesses and frequent doctor visits have a complicated view.
I have two classic examples of errors in billing and reimbursement. When my mother was in Intensive Care and ultimately passed away, she had met her out-of-pocket maximum within a day of being admitted. However, guess who got a bill for five figures? Me, the Personal Representative for the estate. If I wasn’t already looking into everything that came to my house, this was one that made me jump backwards. After making a few phone calls, verifying coverage with insurance, speaking to the hospital, and then speaking with insurance again…the end result was pretty miraculous. Or maybe it was someone savvy enough to be paying attention. In one day, less than eight hours from the first call to the last, that bill dropped to $0.
Even assuming that mistakes this large don’t happen everyday, what about the hundreds of smaller errors that don’t get caught?
Another situation was for something that the hospital didn’t charge for. I caught it on my explanation of benefits and compared to my bill. This prompted me to contact the hospital and have the billing resubmitted.
If you don’t do anything else, try to make a practice of comparing your statements and your EOB. Too many times things are overlooked. I would be curious to know how many people pay bills because they never reviewed the paperwork. Never, ever, ever assume.
It’s not quite like winning the lottery, but wiping out a five figure bill in under eight hours, is a great feeling! Do you have any similar experiences?