People don’t realize that an incorrect diagnostic code will cause the insurance company to deny a claim, or that there might be charges on a bill for services not actually rendered. I counsel people to read those statements carefully.
MONROE, N.Y. (PRWEB) February 25, 2015
Most people who get a medical bill believe they must pay what the statement says they owe. However, medical bills may not be correct, insurance might not have been properly billed, and many consumers are left with the headache of unexpected health care expenses that can be difficult to pay off.
Adria Gross, president of MedWise Insurance Advocacy, recommends that consumers ask five questions before blindly paying a medical bill. Her firm helps individuals sort through through their medical bills and insurance claims to make sure they are receiving the proper reimbursements or are not being overcharged or incorrectly billed.
“People don’t realize that an incorrect diagnostic code will cause the insurance company to deny a claim, or that there might be charges on a bill for services not actually rendered,” she warned. “I counsel people to read those statements carefully and ask themselves or their providers several questions that can save them a lot of money.”
- Is the statement fully itemized?
Gross advises looking for dates of service for each office visit and/or procedure or test, with the provider’s charges and any insurance payments applied to the bill. “Do not accept a statement with only total charges and total amount owed on it,” said Gross. If an itemized medical bill is not received, contact the provider’s billing department and request one.
- Are the billed services the ones you received?
Human and machine errors do occur and treatments, visits or tests could be duplicated by mistake. Of course, there is a chance that the incorrect billing was intentional so read the itemizations carefully and don’t be afraid to speak up. Examples of billing errors include billing for a private hospital room when the patient was in a shared room or being billed for a test that was canceled before it was administered. “Whether or not there is a suspicion of foul play, always keep a record of procedures, treatments and office visits as a proactive measure,” Gross said.
- Do charges align with the EOB?
The insurance company will issue an explanation of benefits (EOB) after processing a claim. The EOB will show what the insurer considers “reasonable and customary” fees for various services, how much went towards the deductible, what was covered, and what the patient might still owe the provider. Gross advises patients to double-check the EOB against the medical bills received for any outstanding balance to make sure that all charges are correct and that potential overspending is curbed.
“Many people are overwhelmed by the paperwork, and become confused about what their health insurance really covers or what’s considered in-network or out-of-network,” explained Gross, who worked in the insurance field for over 20 years and is well-versed in medical billing procedures.
- Is all the identification information correct?
Consumers should insure that the name, address, and health insurance policy numbers are all correct, as well as the contact information and insurance numbers for the physician or facility. If the consumer has changed health insurance, that person should provide an update to the healthcare provider and have the billing department re-submit it to the correct insurance company.
- Were the correct CPT codes used?
The CPT codes—or current procedural terminology codes—must be correct and must indicate medical services that the policy covers in order for the claim to be processed rather than rejected. These codes apply to both diagnosis and treatment. The American Medical Association’s website has a CPT guide consumers can use.
Anyone who suspects fraudulent or incorrect charges or has been denied insurance coverage they should get according to their policy may dispute the bill or the EOB. For many people, the correspondence with the insurance company and medical provider can be daunting and the paperwork confusing, which is where medical insurance advocates can help.
Ms. Gross says that she is often contacted by individuals or their families to help figure out what they really owe, and to resubmit claims to insurers or talk to the medical provider about reducing fees for procedures that are not covered. “It is very gratifying when MedWise Insurance Advocacy can help someone who’s recovering from an illness or surgery by relieving that stress for them during a sensitive time.”
For more information about MedWise Insurance Advocacy, contact Adria Gross at (845) 238-2532 or medwisebilling@optonline.net, or go to http://www.medicalinsuranceadvocacy.com.
About Adria Gross
Adria Gross is CEO of MedWise Billing, Inc. a medical billing and credentialing firm that works with healthcare providers; and its subsidiary, Medwise Insurance Advocacy, a medical-billing advocacy company that assists health insurance customers in disputes with their insurers. She supports individuals and their families, and elder law and personal injury attorneys on medical claim matters. Gross previously worked as a claims examiner with Blue Cross/Blue Shield and American International Group. For more information visit MedWiseBilling.com and MedicalInsuranceAdvocacy.com
