You know, this past year, or maybe even the past couple of years, I have started reading my insurance EOBs....it's a summary of your healthcare visit and it has those medical codes...followed by procedures or orders from the doctor or lab. This is a summary of what the office staff sends to the insurance company to pay. I remember, it amazed me just how a local optimologist billed the insurance 3 times on 3 different dates a couple of years ago. He was merely doing a second evaluation. He billed for surgical things....and later tried to bill me for the co-pays the insurance wouldn't pay!!! I had a good fight over that one. I think the doc went out of business....but I learned something. I now read them every time I get one in the mail. Our economy has been overwhelmed with all kinds of people trying to find money...anywhere. It is no surprise, with Medicare reducing payments to doctors, hospitals and labs, that their staffs' might or kinda, plump up a bill?
I read this week there are things you should look for, but first, this is what I do after visiting a medical service:
1) keep the receipt and my payment, take it out of my purse and put it into a folder which sits where I keep my bills;
2) when the insurance EOB or summary of payment comes to my mailbox, (sometimes I may have several from the same visit due to secondary insurance submitals, hospitas, surgery, etc.) I match it with my receipt.
**Frequently, it takes several weeks to obtain all the summaries from the insurance companies.
3) I methodically go down through the summary and look for mistakes in procedures, dates, services, etc.
4) I review all receipts for same service date to see if the physician or other has submitted double!
5) If I spot a problem, I phone the insurance carrier to ask questions regarding the co-pays, etc and alert them you have a possible mistake in billing.
6) Call your medical admin staff who is responsible for the mistake! ask them to substantiate their coding and perhaps it is a misunderstanding?
**Eventually, if you do not report a mistake and it will (9 out of 10 times) come back to you as something the insurance will not pay or that the co-pay is expected in volumes that are fraudulent due to the overbilling mistake. You will be responsible for the balance which the insurance did not pay, if you do not scrutinize and say something to the medical staff. See my links below for advice and assistance.
Here's what I look for when my EOB or healthcare summaries arrive:
1) confusing codes and abbreviations you don't understand
2) Double billing either by same entity or comparable entity for same service
3) Typos and/or arithmetic not adding up correctly (by accident of course)
4) Charges for something the doctor did not order
5) Padding charges to collect co-pays from the insurance company and then charging you as well
6) Incorrect dates of service or stay in a hospital
When all is well with that particular date of service (can take a few weeks) you will be assured your co-pay is legitimate and you will be able to phone the billing department of the medical staff and make payments on your share...feeling confident you have not fallen victim to medical nonsense and economic greediness.
Here are 2 links you might find helpful:
shiptalk.org for State Health Insurance Assistance Program, or SHIP
Please come visit me at BWs Recollections! bwsrecollections.webstore.com
I do have a few things auctioning on Ebay this week:
Happy Trails, Happy Health. and then there's poker.......