How to Navigate the Maze of Medical Billing

We have already written about the impact of medical debt, how to mitigate its negative effects and how to plan your medical expenses so you don’t get into debt, but strategies are only as good as how we put them into practice. Recently, our family has been dealing with medical bills from several different providers and organizations. We felt firsthand the convoluted and archaic system that is not consumer friendly. The following examples from our personal experience illustrate some common pitfalls and potential solutions.

Look for papper bills By letter

At a time when almost all financial transactions are done digitally, medical billing is still done on paper. You can link your utility and credit bills to your online banking account, hit your phone at the grocery store, and Venmo your plumber, but your medical bills still come in the mail. Even for hospitals that have a patient portal, not all of them integrate the billing function. We certainly missed payments because the invoice was thrown away with spam. Lesson 1: Look for medical bills in the mail.

Ensure that all complaints are submitted

Our daughter went to an urgent care clinic for a sprained ankle and received a splint to stabilize her foot. A few months later, once the incident had been forgotten, we received an invoice for $250 (in triple carbon copy) from the manufacturer of the foot orthosis. Upon calling the insurance company, we learned that a claim had been submitted for the doctor’s service but not for the brace which counts as medical equipment. We then called the manufacturer who redirected the invoice to the insurance company. Lesson 2: Make sure insurance claims have been submitted.

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Check pend of insurance Payments

It usually takes three to six months from when you receive care to when the provider is paid by the insurance company. During this time, the provider may use a different billing cycle for patients. One of our doctors sends us an invoice one month after each visit for the total balance of our account. Once insurance pays its share, the actual amount we owe the doctor is a fraction of what is on the bill. So we call the billing manager who either subtracts the expected insurance amount or just tells us to wait for the bill to be updated on the next cycle. Lesson 3: To avoid overpayments, check any pending insurance.

How much do I really have?

After submitting a claim, the insurance company sends you an Explanation of Benefits. This document indicates the amount invoiced by the supplier, the amount paid by the insurance, the amount amortized due to the contractual discount and the amount designated as deductible, copayment or co-insurance. Review each EOB to determine if cost sharing is what you expect. Once we noticed that there was a deductible indicated for a preventive visit and it turned out that the request had been submitted under the wrong code. The most important information on the EOB is the “patient liability,” or the amount the insurance company estimates you should pay the provider. Clarify any discrepancies before making a payment. Lesson #4: Compare EOB and your medical bills side by side.

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How dealing with “glitchy” online payments?

We received a bill from the pediatricians who treated our son in the hospital right after he was born. We visited their office and were told that they do not accept payment in person. Instead, we were given a QR code for their “new online payment system”. The website was faulty and did not display the updated balance. Then we called the billing hotline, but the customer service rep was working from home and couldn’t accept payment over the phone. We ended up sending a check after all. Lesson 5: Be patient as the medical billing industry adapts to the modern world.

Finally, we would like to acknowledge that thanks to a rule change in July, medical debts under $500 are no longer reportable in credit history. There will also be a one-year grace period before larger medical debts show up on credit reports. In addition, any fully paid medical debt will be immediately removed. This will give patients more time to pay their medical bills and significantly reduce the adverse consequences of missed payments.

Qing Yang and Kevin Parker are a married couple living in Springfield. Dr. Yang is an anesthesiologist. She received her medical degree from Yale School of Medicine and completed her residency training at Massachusetts General Hospital. Parker has helped formulate and administer public policy in various municipal, state, and federal government entities, including the Illinois Department of Innovation and Technology and the Illinois Emergency Management Agency. This column is not intended to replace professional medical advice, diagnosis or treatment. The opinions are those of the authors and do not represent the views of their employers.

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