Navigating The Complex World Of Medical Bills: When To Involve Your Insurance Provider

Medical bills can be daunting, but they are often negotiable. In fact, negotiating medical bills can lower your annual healthcare costs by thousands of dollars. If you have insurance, it is worth calling your insurance company to negotiate your hospital bill. Before you start negotiating, it is important to understand your insurance coverage. Log in to your insurer's website and check your plan details to see what your insurance covers and what you are responsible for paying. You can also check your explanation of benefits (EOB) to see what your insurer has covered in the past. If you notice any discrepancies or have questions about your coverage, contact your insurer for clarification. It is in their financial interest, so waiting on hold is worth it if it means you can significantly reduce your medical bill.

Understand your medical bill

Medical billing in the United States can be a convoluted process, with 72% of American consumers confused by their medical bills and 94% receiving bills they consider too expensive. However, understanding your medical bill is the first step in negotiating lower costs. Here are some tips to help you decipher your bill:

Request an itemized bill

An itemized bill breaks down all the charges, including the cost of each procedure, medication, and service. This allows you to see exactly what you are being billed for and identify any errors or discrepancies. You are entitled to an itemized bill, but you usually have to request it.

Double-check your medical codes

Medical bills contain codes for identifying medical goods and services. The two most common types of medical codes are the Current Procedural Terminology (CPT) codes, which represent specific procedures, and the International Classification of Disease (ICD-10) Codes, which denote specific ailments. You can use resources like the American Medical Association (AMA)'s website to look up these codes and understand what they represent. Cross-referencing the codes in your bill with the AMA’s list will ensure you were billed correctly.

Verify your insurance coverage

Before negotiating your medical bill, it's important to understand your insurance coverage. Log in to your insurer’s website and check your Plan Details to see what your insurance covers and what you are responsible for paying. You can also check your Explanation of Benefits (EOB) to see what your insurer has covered in the past. If you notice any discrepancies or have questions, contact your insurer for clarification.

Identify billing errors

Billing errors are common and can significantly reduce your medical bill. Common billing errors include duplicate charges, incorrect patient information, incorrect codes, and unbundling of charges. If you find any errors, document them and contact your provider’s billing department to have them corrected.

Research comparable rates

If you find that your bill is significantly higher than the average rates in your area, use this information to negotiate a lower price. Letting providers know you’ve done your research can save you a lot on your medical bills.

Prepare for the negotiation

Having the necessary information and documentation makes your negotiation more effective. Before contacting the billing department, make sure you have a copy of your itemized bill, any documentation of billing errors, and research on average costs for the procedures and services in your area.

Stay calm and persistent

Remember to be polite and courteous in your negotiations. Raising your voice or talking over the other party will almost never help your chances. Explain your case, and if you need to, appeal to a higher power.

Verify your insurance coverage

Verifying your insurance coverage is a crucial step in the process of negotiating medical bills. Here are some detailed instructions to help you navigate this step effectively:

• Collect Patient Information: Begin by gathering all the necessary information from your patient. This includes their name, date of birth, insurance company, policy number, group number (if applicable), insurance ID, and the phone number provided on their insurance card. It is also important to inquire about secondary insurance and collect similar details if the patient holds multiple policies.
• Contact the Insurance Provider: Reach out to the patient's insurance provider by calling the phone number listed on their card. It is recommended to initiate contact at least 72 hours before the patient's initial visit to allow sufficient time for verification. When speaking with a representative, confirm that they are authorized to provide patient information and ensure that the conversation is HIPAA-compliant. Provide them with the patient's information and ask any relevant questions to understand the specifics of their coverage.
• Ask the Right Questions: During your conversation with the insurance representative, inquire about the active status of the policy, its expiration date, the patient's copay and deductible, and any applicable coverage limitations or requirements. Confirm whether the patient's insurance plan covers the specific procedures, diagnoses, or services they require. Additionally, ask about the number of therapy visits or similar services covered under the plan.
• Record the Information: It is essential to accurately record all the information obtained from the insurance provider. Enter this data into the patient's electronic medical record (EMR) or a similar system. Make sure to include details such as the insurance name, phone number, claims address, policy effective and end dates, copay, deductible, and any relevant limitations or requirements.
• Reverify Periodically: Insurance information can change over time due to various factors, such as changes in employment or personal circumstances. Therefore, it is recommended to reverify the patient's insurance coverage periodically, ideally on a monthly basis. This helps ensure that you have the most up-to-date information and reduces the risk of surprises or discrepancies in coverage.

Identify billing errors

Billing errors are more common than you might think, and identifying them can significantly reduce your medical bill. Here are some common billing errors to look out for:

• Duplicate charges: Make sure you are not being billed twice for the same procedure, medication, or service.
• Incorrect patient information: Double-check your personal information, including your name, address, and insurance details, to ensure there are no mistakes.
• Incorrect codes: Check the CPT codes on your bill to ensure that the correct procedures and services are listed.
• Unbundling of charges: Some procedures are billed as a package but are sometimes billed separately, leading to higher costs. Verify that you are not being overcharged due to unbundling.

If you find any errors, document them and contact your provider's billing department to have them corrected. If you are trying to negotiate hospital bills after insurance has already been involved, it's not too late. Call your insurer or write a letter of appeal to get the charge reduced or removed.

• Obtain an itemized bill: Request an itemized bill, which breaks down all the charges, including the cost of each procedure, medication, and service. This will allow you to see exactly what you are being billed for and identify any errors or discrepancies.
• Double-check medical codes: Medical bills contain codes for identifying medical goods and services. Use resources like the American Medical Association (AMA) website to look up these codes and understand what they represent. Cross-reference the codes in your bill with the AMA's list to ensure you were billed correctly.
• Compare costs in your area: To determine if your bill is reasonable, compare the prices of the procedures and services with the average costs in your area. You can use resources like Healthcare Bluebook or Fair Health Consumer to find this information.
• Review your insurance coverage: Before negotiating your medical bill, understand your insurance coverage. Log in to your insurer's website and check your plan details to see what your insurance covers and what you are responsible for paying. You can also check your Explanation of Benefits (EOB) to see what your insurer has covered in the past.
• Contact your provider: If you have questions or concerns about your bill, don't hesitate to contact your healthcare provider's billing office. They are used to negotiating and can help you understand your bill and explore options for reducing your costs.

Research negotiation strategies

Before approaching the billing department or your healthcare provider, it's important to research different negotiation strategies. Here are some tactics to consider:

• Offer to pay upfront: If you can afford to pay a portion of the bill upfront, you may be able to earn a discount. Healthcare providers are often more likely to offer a reduced rate if they know they will receive payment promptly.
• Ask about a payment plan: If you can't afford to pay the entire bill at once, ask about setting up a payment plan. Many providers are willing to work out a plan that fits within your budget. As with upfront payments, the security of a payment plan may convince providers to offer a discounted rate.
• Negotiate based on comparable rates: If you find that your bill is significantly higher than the average rates in your area, use this information to negotiate a lower price. Letting providers know you've done your research can save you a lot on your medical bills.

Prepare for the negotiation

Having the right resources with you will make your negotiation considerably more effective. Before contacting the billing department, make sure you are prepared with all the necessary information and documentation, including:

• A copy of your itemized bill
• Any documentation of billing errors
• Research on average costs for the procedures and services in your area

Stay calm and persist

Remember to be polite and courteous in your negotiations. Raising your voice or talking over the other party will almost never help your case.

Prepare for the negotiation

Before contacting the billing department, make sure you have all the necessary information and documentation. This includes:

• A copy of your itemized bill
• Any documentation of billing errors
• Research on the average costs for the procedures and services in your area

It is also important to understand your medical bill. Request an itemized bill, which breaks down all the charges, including the cost of each procedure, medication, and service. Double-check your medical codes and verify your insurance coverage. Identify any billing errors, such as duplicate charges, incorrect patient information, incorrect codes, or unbundling of charges.

Additionally, be prepared to discuss your financial situation. Have a recent tax return or other financial documents handy, as the billing office may decide on a reduced fee based on your income level.

Frequently asked questions