Preventing and Solving Medical Billing Errors

Basic information you should know on preventing and solving billing errors

Have you ever had a bad experience with a hospital bill and just didn't know how to fix it? Didn't you wish you were more knowledgeable in this area so that it could have been resolved easier? Some common problems with billing are outdated insurance cards,incorrect insurance cards, failure to obtain pre-certification, failure to supply secondary insurance and not being familiar with your benefits. All these are legitimate causes for billing errors. The most common and number one cause of billing problems is an outdated insurance card. Health care benefit plans are constantly being changed, revised and procedures often being updated. In addition, people often change jobs, so, you can understand how easy it is to use an outdated insurance card. When you receive a new insurance card, throw away the old one by destroying it first, and be sure to replace it with the new card immediately.

Failure by the consumer or the physicians office to obtain pre-certification before a procedure or an admission into the hospital is another common reason for billing problems. If approval is not obtained prior to procedures or admission into a hospital, insurance companies will not pay for services already rendered. Usually 24 hours notice to insurance companies is the designated time frame necessary for pre-certification.The phone number is located in the back of every insurance card.

If you are covered by more than one insurance carrier make sure you give the provider all important and relevant information. This often applies to the elderly population who have Medicare plus a supplemental insurance or secondary insurance. In addition to their primary insurance, patients can also be covered by their spouse's insurance. Some secondary insurances are B/C & B/S, AARP or a miscellaneous insurance. Be sure to present this information prior to any services, procedures or hospital admissions, so that you will be billed accurately.

Be familiar with your benefits plan, it could be difficult and confusing to understand what procedures you are covered for. Consumers need to read the manual associated with the benefit plan thoroughly. Be aware of terms such as "medically necessary" and "exclusions". If you are elderly and need assistance, have one of your children help you or a friend. If you are still having difficulty understanding the benefits, or if you are an employee, call the benefits department or go to the employees benefits manager for clarification.

Read all bills as you receive them and keep records of all your bills. If you notice a problem, call the billing department of your insurance carrier immediately. If you have been billed incorrectly or have been denied coverage, you have the right to appeal the decision and must receive an answer within 90 days. If you receive a bill from the hospital and it is a "self pay bill" or the secondary insurance information is missing, contact the hospitals billing department immediately and furnish them with the correct information.

Consumers can also experience confusion over multiple bills they receive during a single hospital stay. Expect to receive a bill from each provider--such as the admitting physician as well as the primary physician, consulting physician, emergency department, radiologist, and the list can go on. Get acquainted with the physicians that treat you while in the hospital. Write their names and specialty on a pad, then when the bills arrive, there will be less confusement.

Here are some pointers on how to prevent billing problems:

*Make sure your bill is indeed a bill and not an EOB (explanation of benefits).

*Always pay your bill to prevent your name from being turned over for collection and possibly having your credit ruined.

*Keep and file all bills, receipts, invoices, copies of check in chronological order and always be sure to get the names of every person you speak with.

* Carefully read billing statements from doctors, hospitals and insurance companies. Don't assume the insurance carrier will take care of it.

*Call immediately if you notice a billing error has been made, or if you don't understand the bill.

*Make sure you get the name and phone numbers of all the people you speak with in hospitals, doctors billing office and insurance companies.

*Be persistent, there is a time frame for answering disputes.