CUT YOUR MEDICAL BILLS

Health care costs are high enough, so you certainly don’t want to be over-paying. That’s right. According to one study, 8 of 10 hospital bills contain billing errors.

Medical billing mistakes are really common. Charges are typically based on a patient’s diagnosis code, and a mistake in the code can result in a higher bill than is appropriate.

As an example, here’s one recently reported in the consumer reports money adviser. A person stepped on a piece of glass and went to a podiatrist to have it removed. The procedure took just a few minutes, but the bill came back at $363. When the patient followed up, he found that the billing code was incorrect. Two codes were used: one for a new patient evaluation which lasts 20 minutes, much more than the actual time spent. And the second for “removal of an object by incision,” though no surgery was actually involved. After the patient brought these apparent coding errors to the insurer’s attention, the codes were corrected and the bill was reduced from $363 down to $77.

These codes are complicated. What can we do, since we are not medical experts, to check to make sure our bills are correct? Here’s no easy answer. First ask your doctor what procedures he’s doing at the time of service so you can compare the bill and the explanation of benefits closely. If something seems wrong, or the bill seems too high, call the hospital, doctor, lab, or insurance company. You have a right to know what the charges are for and what the codes mean. If you cannot get a straight answer, or you believe that there’s a mistake that the provider or insurer refuses to correct, then contact the insurer’s fraud department, or the Medicare company that paid the claim, or the state insurance department. In Ohio, the insurance department website is http://www.ohio.insurance.gov/, and the fraud division telephone number is 1-800-686-1527.

Even if Medicare or insurance has paid your bill, you still need to take action. If Medicare or your private insurance company is paying mistakenly inflated bills, we all end up paying more. We all need to check our bills closely and make sure they are not mistakenly inflated.

Check your medical bills closely, and contact the doctor or hospital if it doesn’t add up. You certainly don’t want to pay too much. If we all take a few moments to watch for mistakes, we can do our part to keep Medicare and insurance costs down.

Copyright © Budish, Solomon, Steiner & Peck, Ltd. This article may be reproduced with proper attribution to the law firm of Budish, Solomon, Steiner & Peck, Ltd.  

NEW RULES FOR APPEALS OF HEALTH INSURANCE CLAIM DENIALS

Your health insurance claim is denied, and you disagree. So you appeal. But the appeal seems more like a kangaroo court, since the insurance company itself decides your appeal. If that doesn’t seem fair to you, you are not alone. It didn’t seem fair to congress either, and they have now changed the rules.

Insurance companies make a variety of decisions that affect consumers. For example, your claim for medical care, or a hospital visit, may be denied. Or your health insurance coverage might be cancelled. Typically, the insurance company provides a procedure to appeal its decisions. And in most cases, the appeal is to the insurance company itself.

The new health care reform law provides for new regulations that expand consumer appeal rights. Maybe most important is the right to have your appeal heard by an independent and external review board. While we are still waiting to learn all the details of how this will work, your appeal now can be heard and decided by people who are not employed by the insurance company itself.

If you work for a company that offers its own health plan and does not contract with an insurance provider, the new right to an independent external appeal process applies to this situation too. Everyone who gets a new insurance plan is covered. The old rules still apply until your plan changes.

It makes a big difference to have an external review process. No matter how much the insurance company tries to be fair, it has a financial incentive to deny consumer appeals. According to the Kaiser Family Foundation, when external review boards have been used previously, 45% of appealed denials have been reversed.
Insurance company denials of health care claims can be costly, and downright aggravating. And it has been especially frustrating to have an appeal process that doesn’t seem fair. Now, under the new health care law, appeals should give you a good chance for a fair hearing.

Copyright © Budish, Solomon, Steiner & Peck, Ltd. This article may be reproduced with proper attribution to the law firm of Budish, Solomon, Steiner & Peck, Ltd.