Taking Charge of Your Medical Claims
Article submitted by Annie and Ron Graves with MediPay, Inc.
For more information, they can be reached at 210-366-3490.
Taking charge of medical bills and insurance paperwork after a hospital stay or illness is something most people leave as the
last concern during their recuperation, and rightly so. But, what you don't know may hurt you, especially if you assume the
insurance company or health care provider will take care of all the details and you won't have to worry about it. Often times delays
in getting medical claim issues resolved can end up in a huge problem that can ruin your credit record and may result in you paying
out of pocket for charges that should have been covered by insurance. Just as healthcare consumers are being advised to be proactive
in minimizing their risk for medical errors which can occur, so too should they be alert on how to be proactive in minimizing their
liability for medical claim errors. Here are some tips for what to look for in managing your medical claim paperwork and how to know
if you need professional help.
- Make sure to present your medical insurance identification cards (Medicare, Tricare and/or Private Insurance Health Plans)
each time you go for an office visit, lab, x-ray, or hospital stay etc. They should update your file so that the claim is routed
to the proper entities following each encounter. Most insurance companies impose filing deadlines for timely processing of
claims, and failure to file the claim to the correct carriers within the allotted time frame may increase the risk of
non-payment on a claim. Likewise, if they have not included the correct ID number or other data on the claim, this could delay
processing, delay payment and ultimately the unpaid claims could become your responsibility.
- Keep a calendar of each time you go for a medical visit to the doctor's office, clinic, etc. When you receive Explanation of
Benefits (EOB) summaries from the Insurance Company (or Medicare,) you can check that claims are being filed for services you
actually did receive. You can also compare the EOB with the statements from providers of care (doctor, hospital, etc.) reconcile
the charges, and check that they have posted payments and adjustments made by the insurance carrier. Make sure the secondary
insurance (if applicable) has paid their portion of the balance which may remain. Make sure to keep these records for at least
two years.
- Question any bills from the provider which indicate that the insurance did not pay. Find out why there was no payment and
review the EOB from the insurance carrier to verify that explanation. Determine if there is anything that can be done to
resolve non-payment on a claim. Check also that the secondary insurance or supplement plan (if applicable) has processed the
claim (even if the primary insurance has denied benefits.)
- If you feel overwhelmed by too many medical bills and are having difficulty sorting them out, not knowing who to pay and how
much, or you feel that denials of claims can be appealed but don't know how to go about it, you can seek the help of
professionals. Start by contacting your insurance agent, senior advocacy groups such as AARP or Area Agency on Aging, or
checking phone book listings for Medical Claims Assistance services in your area.
Taking charge of your Medical Claims from the beginning is like taking charge of your health – better to do something to manage
it while you're still ahead, than waiting till its too late! |
