How to Avoid Costly Medical Bills

Medical billing errors are common and can be costly if they aren’t caught. According to medical experts, 40 to 80 percent of medical bills contain errors, and Kaiser Health News estimates that nearly $68 billion in healthcare spending is lost due to billing mistakes each year.

Martin Rosen, Health Advocate’s Executive Vice President, Chief Marketing Officer and Cofounder, recently appeared on The Willis Report, a FOX Business TV show that focuses on consumer and personal finance issues.  The Willis Report ran a week-long series called “A User’s Guide to Healthcare,” aimed at helping viewers unravel the complexities of the healthcare system and become empowered consumers. Martin served as an expert source to discuss the most common errors found in medical bills and how consumers can better understand medical bills and avoid mistakes.  To view Martin’s appearance on The Willis Report, visit http://www.healthadvocate.com/tv.aspx?v=20130717-FoxBusiness

Health Advocate offers the following tips to help you look out for errors and avoid getting costly medical bills:

Don’t wait to open your Explanation of Benefits (EOB). Your EOB lists a number of items, including patient’s name, provider’s name, type of procedure, date of service, charges to the provider, the cost covered by the insurer and what you may owe.

You’ll want to open up the EOB as soon as it arrives in the mail to make sure everything is correct. If there is an error, such as wrong date of service or you’ve been charged twice for a procedure, it’s best to resolve it quickly. It’s very important to open the envelope as soon as you receive it—if you wait too long to read it or handle any errors, you could lose your right of appeal. The deadline for appealing a claim is typically 45 days.

Be informed.  If you are insured, know the details of what your health insurance plan covers.  Familiarize yourself with the details of your insurance benefits.  Understand how much you’re responsible for when it comes to your deductible, co-pays, and co-insurance.  Learn what services are and aren’t covered under your plan. Being insured does not always mean that all your medical costs are covered. 

Verify that the provider you choose is “in-network.”  Make sure that any labs your provider may use for various tests are also considered in-network.  If the provider and/or the lab and facility the provider is using are in-network, your medical bills will be less costly than out-of-network labs/facilities.

Read your bill carefully. If you’ve had a hospital stay, ask for an itemized bill at the conclusion of your visit.  Be aware that this may not include information on what you or your insurer will be asked to pay, but it could help you spot major errors on your bills.

Ask the hospital for a copy of your pharmacy ledger. This details what drugs you were given through the course of your stay and your medical chart. Look these over carefully to make sure the hospital isn’t charging you for any drugs you didn’t actually take.

Find an advocate.If you are a Health Advocate member and need help understanding a medical bill or EOB, reviewing and explaining your benefits information, finding an in-network provider, making sure your bill contains no errors, filing a claim, and more, give us a call—our Personal Health Advocates are happy to assist you!

Confused by your Explanation of Benefits (EOB)? Health Advocate can help!

When you or your family member goes to the doctor for a checkup, lab work, or other medical tests or procedures, you should receive an Explanation of Benefits (EOB) in the mail. An EOB is not a medical bill. It is an itemized statement that includes the healthcare service you received, how much was charged for the service, what was paid by your insurance carrier, and what you are expected to pay out-of-pocket.

When you first look at an Explanation of Benefits, you may feel a little intimidated by all the information listed there.  Even if the document confuses you, don’t ignore or discard it.  It’s important to take steps to understand your EOB.  Here is a list of the most common information you will find on your EOB statement and how to read it.

Member: This will include your contact information or the contact information for a member of your family who received care. The group number on your insurance card will also appear here. 

Summary of services. This lists the medical services that you or your family member received. This will also list any charges that you may owe and that were not paid for by your insurance company. If you do receive a medical bill, it’s important to compare the bill to the EOB. You’ll want to make sure that you are being billed for the correct services that you or your family member received.

Summary of deductibles and copayments. This column shows you how much of your copays and deductibles you’ve paid to date.

Details of services. This explains what type of care was received, the date of the appointment and the provider’s name. This is very important information to keep on hand. If you receive a medical bill, make sure the healthcare provider on the bill, as well as the date and the type of service received, match the same information on the EOB. Errors are not uncommon, and it’s possible that the bill and the EOB may not match. In order to notice and handle billing errors quickly and efficiently, you should always keep your EOB on file so that you can compare it to your bill.

Allowed amount: This is the contracted amount of payment a provider has agreed to accept for a service, treatment or product from an insurer.  In network providers can collect up to this amount, but out of network providers may balance bill up to their charges.

Balance.  This is the amount that you owe the provider for any deductible, co-insurance, co-pay and non-covered services. You may have paid some of this (for example, your co-pay) at the time the services were provided.

Still feeling a little confused about your EOB? If you are a Health Advocate member, call us—a Personal Health Advocate can help you better understand your EOB.  If necessary, your Personal Health Advocate can also help you resolve any errors you may find on your EOB or medical bill.