View Full Version : dealing with insurance/medical billers
the wingless one
10-11-2006, 07:29 PM
Is it just me or does anyone else get awful stressed out having to constantly deal with your insurance company and the 800 different labs that bloodwork gets sent to. I've moved a couple times since I was diagnosed and it is always such a pain because I'm worried that my various bills from various labs won't get forwarded and I never really know where my doctor is sending my blood tests each time so it's hard to keep track of and even if they did tell me where they're sending them I'd probably forget because they all have such similar names (diagnostic this, lab that) it's totally stressing me out! Not to mention I've gone onto my fiance's insurance recently so all the billers seem to be confused about which account number to bill and some old bills have been being attributed to the new account and vice versa and so they are being rejected. It is just SO stressful and annoying I can't stand it I had to come here and rant because I figure that only people here will understand how much it sucks to be trying to minimize stress while coping with the added stress of dealing with all these bureaucracies and bills! Whew that was a long run-on sentence. Sorry =)
Is there anything to be done about this? I know it doesn't help that I'm not the most organized person in the world but I find it so difficult to keep everything straight. Are there any tips with dealing with insurance and various medical billers? Thank you!
10-12-2006, 10:34 AM
Oh, boy, this is such a big issue for most people, and it can be overwhelming - the trick is breaking it down into small tasks that you can manage. But it is really important to keep track of your medical bills not only to make sure your insurance company is paying, but also because in some circumstances your medical expenses can be itemized and deducted from your taxes come tax time. If your total out-of-pocket medical expenses (this includes health care, eyeglasses, hearing aids, prescription meds) are more than 7.5 percent of your adjusted gross income - they are deductible - which can be important if you've had significant medical expenses, or you are uninsured.
You can buy software designed specifically to keep track of medical expenses, such as Quicken medical expense - or print off medical bill tracking forms
from several sites on the internet. I like a large accordian file because I'm not that much into high tech.
You should make sure that all your medical providers have a copy of your insurance card with the most current account information. Find out if your doctors will file insurance claims for you, and whether they accept insurance assignment. Providers who accept assignment agree to accept the amount your insurer pays, and not charge you for the amounts not covered (this doesn't apply to deductibles and co-pays). Regardless of what your doctor or hospital actually charges, insurance companies and Medicare/Medicaid will reimburse
only the "reasonable and customary" charge for a particular service, and this set amount can vary by where you live. So if your doctor charges $75 for an office visit and your insurer only reimburses $35, you can have a substantial amount of unreimbursed medical bills - that's why it's important to find out your doctor's policy about assignment.
Depending on your particular insurance, you may be restricted to doctors and labs within a certain network, so you should also read your insurance
coverage booklet thoroughly so you understand your coverages, deductibles and co-pays. Always pay your co-pays or other bills by check when possible, so you have proof and a paper trail showing what you have paid.
As your medical bills come in, sort them by the provider and the date of service. Most often, the first bill is a "courtesy copy" showing the amounts
billed to the insurance company. Review the bills carefully to make sure you actually received the services billed - billing errors are more common
than many people realize. Also check the dates of service to make sure you are not getting duplicate bills for the same visit or service.
Almost all medical care providers and insurers require both a diagnosis code (ICD code) and a procedures/services code (CPT code). These are the numerical codes you see on your bills. ICD International Classification of Disease) codes refer to symptoms, injuries, diseases, and conditions, while CPT codes (Current Procedural Terminology) refer to all medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services performed by
physicians, hospitals, and other health care providers. If the two codes are inconsistent, for example, the doctor billed you for a procedure that has nothing to do with the diagnosis code, the insurance company will reject the claim. This is one of the most common reasons why bills are not paid. If this happens, ask the doctor to re-submit the claim to the insurer with the correct codes.
When your insurance company pays a claim on your behalf, it will generally send you an "EOB" form - Explanation of Benefits - showing the amounts it has paid and the amounts denied. There will generally be a "comments" or "remarks" section explaining the amounts not paid. Compare the EOBs to the bills from the providers to see whhat has been paid and what amounts you may owe. EOBs are not bills - once your doctor receives payment from the insurer, the billing office will generally send you a statement for any amounts you still owe. Check this statement against your EOB (going by dates of service, not dates of bills) to make sure the amounts match. The EOB will generally have a contact number you can call for questions about an insurance payment.
If the doctor's bill has an error, you should contact their billing office rather than the doctor, since many doctors hire their billing out to medical billing companies.
Most states have regulations about when insurers have to pay claims, generally within a thirty-day period unless there is a dispute about the claim. If your insurance company denies a claim you think should be covered, you have the right to appeal - this information will usually be in your coverage booklet or in the EOB form. You usually have only a limited time period to file an appeal, often sixty days or less. Most insurance companies
have an ombudsman or customer representative you can contact for help.
Don't be embarrased to be upfront with your doctor's office if your medical bills are a financial hardship - they will generally work with you, and may know about medical assistance or prescription assistance programs you may be eligible for.
Sorry this was such a long response, but it's not an easy topic. Hope this helps.
the wingless one
10-12-2006, 10:31 PM
10-14-2006, 05:33 AM
One thing I found REALLY important to do is; Make a personal file for YOU. Mostly lab results and tests done and even your meds, vitamins, any suppliments you take. KEEP it CURRENT !!!!!!!!
Whenever you have a dr. appointment , take YOUR copy with you. I have found SOOOOOOOOO many times that the lab had not yet sent the results to my Dr. ( or you know the xcuse) they got misplaced! and everyone blames the other one. This way I have my copy with me and I make sure they always are up-to date. BUT, ALWAYS KEEP YOUR COPY!!
even after the appt. I also like to do this because when I want, I can compare results for myself. I have so often found that to a small degree with these lupus issues, WE have to infrm the dr. of progress or regression!!!!!
My ins stuff, I do the same thing; keep a folder!!!
And, it is so confusing in the beginning, once I got on track to keep files for myself, it became much easier!!!!
Even if you have to deal with the ins. company over something, if you have your own file, you can immediatly tell them the date of service, etc.
I won't make this any longer or it too will become harder to read :) :)
JUST MAKE YOUR OWN COPY OF EVERYTHING !!!!!!!!
the wingless one
10-14-2006, 02:16 PM
Thanks for the tips stardust. My mom is forever telling me to get copies of all my labs and whatnot and I know I should but I guess I've just been lazy about it, thinking ohmygoodness there will be sooooo many copies to be made since I've been seeing my rheumy for about a year and a half now and getting blood tests done like once or twice a month, not to mention bone density, urinalysis, and all that fun stuff. Now that I'm going to France though I do think I need to get crackin on asking my doctor's offices to make copies for me so that I can bring them with me in case God forbid anything should happen while I am abroad (knock on wood that I stay healthy there though!).
Anyway, thanks again both stardust and Marycain for all your advice, I need to just suck it up and quit being lazy about it and stay more organized...
10-14-2006, 03:26 PM
Even if you can't backtrack all of them, start now! and maybe with the most recent ones for your trip.
Another huge help is when you do travel, make sure you carry enough meds in case something gets lost.
I found that out the hard way, on a flight; I had put all my meds only in my suitcase, of course they lost my suitcase for 5 days. It was a REAL PAIN "in the u know what" to get to pharmacys and have them call the Dr. . Now, when I fly, I put a supply in my purse (in case they loose my luggage) AND a supply in my luggage ( in case I loose my purse.)
SUCH A PAIN !!!!!!!! TALK ABOUT PARANOID !!!!!! :) :) :)
10-14-2006, 04:41 PM
It's a pain, but necessary - allow yourself at least 2 hours to get thru security and don't forget you can't put a lot of items in your carry on luggage now - no liquids, gels, etc. except for the travel-size toiletries (3 ounces or less) that fit in ONE, QUART-SIZE, clear plastic, zip-top bag -put anything else in yout checked luggage or it will be thrown away by airport security. Make sure your prescription meds are in the original pharmacy containers - if you are diabetic and need insulin vials, glucose gel strips etc., you MUST have a letter from your doctor certifying you are a diabetic. If possible, put your meds in the clear bag, if they will not fit because of the size, remember you must declare them at the screening checkpoint. If you are flying a non-US airline like AirFrance, they may have additional restrictions - some non us airlines do not allow any carry on luggage at all now, so check ahead of time - before you pack!
If you haven't flown in the last 2-3 months, be as prepared as possible for the security process so you don't get too stressed out. Wear slip-on shoes so that you're not trying to juggle your carry-on bags while tying your laces. Everyone has to remove their shoes for x-ray, even children. Avoid wearing jewerly and accessories made of metal (belt buckles, etc.). The more objects you have to take off at security, the more hassle and the longer the delay.
In both your carry on and checked luggage, keep your clothes and personal items organized in clear plastic bags so the security people can search your bag easily with a minimum of fuss. Try not to cram your luggage too full - it's a nightmare trying to repack if your luggage is searched and the TSA people can't fit in all in the way you had it. I'm one of those people who packs everything so tightly you couldn't squeeze in an extra thing, so that's one habit I had to unlearn.
I hope you have a wonderful trip to France - it's a great time of year to be there!