| Medical bills and health insurance are often tedious | | | | hospital can provide them. If you still have |
| and difficult to understand. Healthcare reform is | | | | questions about your coverage, call your insurance |
| making its way through the Senate but healthcare | | | | company and ask a representative to explain it. |
| costs are still rising. As a patient it is time to | | | | Remember that your insurance company, not |
| become your own patient advocate. | | | | your doctor, makes decisions about what will be |
| Maya Jinwright of Washington, DC, a medical billing | | | | covered and what will not. |
| manager who has worked in hospitals and | | | | 6. Make sure your insurance company has paid all |
| doctor's offices, haggles over fees for patients | | | | bills correctly |
| without insurance. Jinwright often negotiates with | | | | Once you have seen your physician allow 2-4 |
| the hospital and physicians before patients begin | | | | weeks for the insurance company to process the |
| treatment. She explains, "If a patient cannot | | | | claim. It sometimes helps to follow-up with the |
| afford to pay an insurance premium, they cannot | | | | billing person in your provider's office to make |
| afford to pay the uninsured treatment charges. | | | | sure they have the correct insurance company |
| Most providers will work with me." In some cases | | | | and policy number on file. This simple oversight |
| the discount can be as large as 60 percent, which | | | | can cause claims to be denied unnecessarily. When |
| is in line with what a major insurance company | | | | the claim is processed your insurance company |
| would have paid. | | | | will send you a notice of payment called an |
| Use these ten tips to ensure you do not become | | | | explanation of benefits (often called an EOB). This |
| a victim of medical debt. | | | | notice shows what your insurance company paid, |
| 1. Obtain health insurance | | | | what your provider's office billed and what you |
| Health insurance premiums are at an all time high. | | | | are responsible to pay as the patient. If your |
| However, the amount that an elective surgery will | | | | insurance company did not pay an item contact |
| cost out of pocket is much higher. "Patients often | | | | them immediately for details and start the appeals |
| have no idea that medical expenses tend to be | | | | process. Most claims submitted are not paid on |
| exorbitant," says Tara Robertson, medical debt | | | | the first try. Subsequently most appealed claims |
| consultant at Full Cycle Medical Management a | | | | are paid. Contact your provider for assistance |
| health care consultant firm. Insurance companies | | | | with the appeal or if you need medical records. |
| have the luxury of contract adjustments to | | | | 7. Be diligent with your insurance company and |
| reduce medical bills by as much as 70 percent. | | | | provider's office |
| But, she says, the average uninsured patient does | | | | If you decide to submit an appeal, mail it via |
| not get this discount. "It's just not something that | | | | certified mail or keep the fax confirmation for |
| most physicians or hospitals explain," Robertson | | | | your records. Allow 2-4 weeks before calling to |
| says. | | | | check on the status of your appeal. Be sure to |
| If your employer does not provide insurance or | | | | take note of the insurance representative's name, |
| you are unable to afford the monthly premiums, | | | | date and time of the call. Enlist the help of your |
| you may be eligible for Medicaid. Generally seniors, | | | | provider's office. Most physicians have full time |
| disabled individuals, children and parent of | | | | billing staff that can submit appeals. They can |
| dependent children are eligible for Medicaid if they | | | | provide additional information and pointers. |
| have low incomes. Often patients with large | | | | Sometimes your insurance carrier will request |
| medical bills can qualify for temporary Medicaid or | | | | additional information from you or your provider. |
| medical bill assistance. | | | | Complete the forms they send and return them |
| 2. Choose the plan that is right for you | | | | immediately. If you have dependents in college |
| There are several choices when it comes to | | | | you will need to show proof of enrollment every |
| health insurance; Indemnity, PPO, or HMO plan: | | | | semester. If you have a primary insurance and a |
| With indemnity coverage, the beneficiary pays a | | | | secondary insurance you are asked to complete |
| portion of costs and the insurance company pays | | | | coordination of benefit elections annually. |
| the rest. Most plans today are HMO (health | | | | 8. Pay your medical bills in a timely manner |
| maintenance organization) or PPO (preferred | | | | For most insured patients co-pays are paid as |
| provider organization) managed care plans. With | | | | soon as you arrive at the doctor's office or |
| these plans, the beneficiary pays a co-payment | | | | hospital. Co-insurance and deductibles are |
| for medical care visits and has an annual | | | | calculated after the visit based on the services |
| deductible for certain expenses. Be sure your | | | | provided. Most providers bill on a 30, 60 or 90 day |
| preferred physicians are in the plan's network, or | | | | schedule. Balances left unpaid after 90 days are |
| you might pay higher out of pocket expenses and | | | | often turned over to a collection agency. When |
| co-payments. | | | | this happens you may be subject to additional |
| Beware of high-deductible plans. Beneficiaries carry | | | | fees, late charges and even refusal of treatment. |
| a higher amount of financial risk in exchange for | | | | If you are unable to pay the amount that you |
| much lower monthly premiums. In short if you | | | | owe request a payment plan. Ignoring the medical |
| cannot afford to pay the deductible, this is | | | | bill will not make it go away. |
| probably not the right plan for you. | | | | 9. Do not be afraid to negotiate |
| To help choose a plan, calculate total monthly | | | | As your own patient advocate, be direct. Request |
| premiums for the year, plus total co-payments | | | | to speak to the billing supervisor or manager in |
| and out-of-pocket expenses for the family's | | | | private. Then, be clear and confident. Say |
| health care visits and prescription medications. | | | | something like, "These bills are very expensive. |
| Then look at what one ER visit and one surgery | | | | Would you consider adjusting the patient |
| (or whatever possibility might befall your family) | | | | responsibility to be more affordable?" Or "My |
| would cost with each plan. Also consider the | | | | insurance isn't covering much of the billed amount, |
| lifetime maximum -- a serious illness could exceed | | | | so I am paying out of pocket for care. Is it |
| a $1 million or $2 million lifetime maximum. In | | | | possible to lower the price?" Discussing this |
| addition, consider how often you see the doctor | | | | matter with the billing staff is best, asking your |
| and if you have the need to see a provider | | | | physician is the wrong way to go. Physicians see |
| outside of your local area. | | | | hundreds of patients. Their focus is patient care |
| 3. Take advantage of a flexible savings account | | | | not finance. Rest assured that any discounts are |
| A flexible spending account (also known as an | | | | approved by the physician but asking your doctor |
| FSA) is a tax-benefited account that allows | | | | to discount your bill in the middle of an office visit |
| employees to be reimbursed for medical and | | | | is not appropriate. |
| dental expenses on a pre-tax basis. If your | | | | Offering to pay the balance in full immediately in |
| employer offers an FSA, calculate your | | | | exchange for a discount usually works well. The |
| anticipated annual expenditures to select an annual | | | | office normally incurs fees if they have to send |
| amount that will maximize your tax benefit. Then, | | | | the account to a collection agency to recoup so |
| track your expenses and keep organized records, | | | | providing you a discount is usually easier. |
| this will ensure that you obtain reimbursement for | | | | Ask around to see if you qualify for any financial |
| your expenses. | | | | assistance programs. There are often medical |
| 4. Have a yearly physical | | | | foundations and even medical studies that your |
| Medical profits are not made on healthy individuals. | | | | medical condition or expenses might qualify. |
| Yearly check-ups, a healthy diet and exercise can | | | | In order to negotiate the best possible deal, do |
| stave off a number of health issues. Check your | | | | some research. Sites such as the Healthcare Blue |
| insurance carrier's website, most carriers offer | | | | Book, Vimo, and New Choice Health make |
| wellness programs and free preventive care. | | | | research a piece of cake. With a 20 minute visit |
| Typical wellness programs provide patients a | | | | to these websites, you can find out how much |
| personalized health report. The programs often | | | | local hospitals and doctors charge. In addition, you |
| provide educational materials, weight-loss support | | | | can see the types of discounts insurance |
| groups, fitness classes, a smoking cessation | | | | companies receive. |
| program and personal counseling sessions. Patients | | | | 10. Ask a professional for help if you are in over |
| who participate in these free programs are more | | | | your head |
| likely to have lower health care costs, fewer sick | | | | If the provider or facility will not give you a |
| days and be more satisfied individuals. Preventive | | | | discount or you are overwhelmed by your |
| medicine focuses on health issues that "drive a lot | | | | medical bills, enlist the help of a professional. Full |
| of costs and can lead to costly medical care like; | | | | Cycle Medical Management has specialists who |
| obesity, smoking and stress. | | | | negotiate a reduction on your behalf. Typically the |
| 5. Understand your health insurance plan, be | | | | initial consultation is free and the company charges |
| informed | | | | a fee based on the medical bills that you owe. In |
| Take the time to read your insurance policy. As a | | | | addition the company provides free one-on-one |
| patient it is your responsibility to know what your | | | | coaching, including how to complete and appeal, |
| insurance company will pay for before you | | | | negotiating with your physician's office and/or |
| receive a service, get tested or fill a prescription. | | | | hospital. There is even an online form that you |
| Some services may have to be approved by | | | | can complete to have a consultant contact you. |
| your insurance company before your doctor or | | | | |