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How to Take Control of Your Medical Bills

Last summer my wife had shoulder surgery and eight months later the bills are still coming in. Yes, we have health insurance, but as everyone who’s ever had a large medical procedure knows, you get bills from people you didn’t even know were in the operating room.

I had some idea how to handle this situation already, but this experience has taught me a few things about how to deal with medical claims, and that’s what I want to share.

Here are a few cosmic realities about healthcare and health insurance that we all need to be aware of going into any medical procedure:

  1. health insurance plans are riddled with co-pays and co-insurance provisions—you will always have to pay something
  2. health insurance plans contain exclusions and other gotcha provisions
  3. medical providers are not always good at coordinating with insurance companies
  4. health insurance companies and large healthcare providers are both bureaucracies
  5. we are ultimately responsible for any and all unpaid medical expenses

The best ways to handle all of these obstacles is to get involved (early) and then to be relentless. And I mean relentless!

What to do before your medical procedure

We’ve all heard the saying “an ounce of prevention is worth a pound of cure”—no where is this more true than before a large medical procedure. This is where the financial disasters start and once they do they’re almost impossible to undo. Take charge early and be bold.

Set up a folder and a conversation/action log. It usually takes months to settle a single claim so you need to dig in and organize yourself for the long haul. Set up a dedicated file folder where you’ll keep any communications related to your procedure. This should include medical bills, insurance statements, email copies, and phone conversations.

Speaking a phone conversations, set up a phone log where you’ll record the date, time and purpose of a call—outgoing or incoming—along with the name, position and phone number of the person you spoke with. Make sure there’s room to describe what transpired with the call and be as detailed as you can. All calls related to your claim should be included in the log.

Verify your coverage. Never make the assumption that a procedure or surgery is covered, and don’t leave it to the administrative staff at the provider to verify. It’s your health insurance and your responsibility to investigate.

At a minimum, call your insurance company to verify that your procedure will be covered. Ask for a mail or email confirmation, and if they won’t do that (they often won’t), make a second call in reference to the same issue but to a different person at the insurance company. Include details in your phone log.

Pre-certifications. You can’t afford to drop the ball on this one! My wife needed several pre-certs, and none were provided to the insurance company by the provider—every claim was held up as a result! We were able to get all of the pre-certs after the fact and had one in our file already so all claims were ultimately paid. Pre-certs are the key to the entire healthcare provider/health insurance company relationship, so my advice is to get a copy of the pre-cert for any procedure you have before having the procedure done. This step is SUPER important.

What to do after your medical procedure

Even if you did all the right things prior to surgery there will still be bills coming in. What do you do then?

Stay on top of the medical bills. There’s often a tendency to ignore medical bills under the assumption that the insurance company will take care of it. Don’t make that assumption—ever. Review all bills when they come in to see what’s being paid and what isn’t. If a bill sits out more than a few weeks there’s usually a problem (like no pre-cert obtained). You need to get involved as soon as you see this happening. Medical bills don’t get better with age—the longer they sit outstanding the fewer options you have.

Be the go-between for the provider and your insurance company. Usually providers and insurers coordinate as part of a network group, but that’s never as cozy as it sounds. You must get involved, especially when the process seems to be breaking down, and it will at some point. Yes, the provider should furnish everything to the insurance company, and yes, the insurance company should follow up if they don’t, but that’s not always what happens. When it comes to anything medical you are your own best advocate. Get involved to what ever degree is necessary.

Dealing with large balances insurance wouldn’t pay. This can happen even if you have insurance. A $2,000 deductible and a 20% coinsurance provision (up to just the first $10,000) can leave you with a $4,000 bill after insurance had paid their portion. Ignoring this can lead to collections calls and problems with your credit report so it’s best to make an effort to work something out.

If you don’t have the money to pay immediately call the provider and work out a payment arrangement. Most providers will work with you on this, and if they won’t, offer to pay a large chunk up front as a “down payment”. If the bill puts you in a financial hardship let the provider know—they’ll sometimes forgive a portion of the bill.

Never get nasty with anyone, but rather try to enlist their sympathy and you’ll get a better arrangement. There are no set rules here so you’ll need to bring out your inner negotiator and do your best. If you don’t feel able to do this, get a trusted friend to do it for you.
As much as we’d like to believe that we shouldn’t have to worry about any of this (because we have insurance) the reality is quite different. Any medical procedure sets off a chain reaction of financial issues that are best dealt with quickly. When you have a plan and you know what needs to be done to bring it all to an end, you’ll save time, aggravation—and money.

Have you had to deal with the financial fallout of an expensive medical procedure? What other tips would you recommend to someone going through it now?

( Photo from Flickr by Daquella manera )


4 Responses to How to Take Control of Your Medical Bills

  1. Hi Kevin:

    I did not get a notification that you posted this and was under the impression that by signing up for your FREE updates that I would. Did I get this wrong? If I did, any suggestions on how to get these kinds of notifications if you have this option? I get busy and like to be able to hang on to my notification emails from the sites I support for when I have some time to go see the NEW material.

    Okay, on to your post. Raising medical bills can be a challenge in these times whether you have an income or not. Bottom line, me personally, I work on a daily basis to keep myself healthy. LOL, I do have my days of eating too much junk food but trusting God to help me decrease those days as our body needs “fuel” if it is going to be able to take us to the places we need to be – job interviews, taking care of kids and so on. Now when it comes to emergencies, I do realize we sometimes do not have control over those. With those, I TRUST God with them as a lot of emergency rooms in this area I am told (I have not had to visit one since moving here a year ago, thank you JESUS!!!) – are now asking if you have insurance. Yikes!!! While I totally understand their concerns about keeping the facility open and being able to pay their staff – isn’t this against the law? Like discrimination?

  2. Hi Angela–You’re correct in what you’re saying about the updates, however there is a delay in delivery (3rd party service, so not sure why this is). It just went up this morning so it may be later today or overnight before it’s actually delivered. Most of my posts go up late in the evening so the email arrives in the morning.

    I hear what you’re saying about junk food–it’s cheap and when money’s tight it calls to you! I eat more than my share of it and try to compensate by excercise. But we have to make trade-offs and deal with them the best we can. I have teenagers so junk food is here whether I buy it or not.

    On the emergency room situation, my understanding is that they have to take you even if you have no coverage or can’t pay up front. Maybe they’re all getting tougher with that since times are hard even in hospitals, but they still shouldn’t refuse you. It may depend on individual state laws and this may be what you need to look into as I am not an expert. We’re just trying to deal here with the financial mess that all things medical seem to leave behind.

  3. Another huge problem is that there are a lot of medical billing errors and I believe some of them are intentional. For example, we got a huge bill from the hospital for my daughter’s unrinary tract infection. After I called and asked for an itemized bill, they had it miscategorized as a emergency response, like for a trauma patient. We walked in and they gave her an Advil and an antibiotic. I sent in a partial payment and disputed the rest of bill in writting. But, they still refused to correct it. It was a nightmare.

  4. Hi Bret, I wanted to cover that topic as well but the post was already at 1000 words so it was time to cut it off! It seems that the billing set up in the medical profession has gotten so complex that they can stick just about anything in there! The bills are overwhelming and because of this I think a lot of people just assume they’re right.

    They also seem to bill you for everyone in the hospital or facility who was on duty the day of your surgery, whether or not they had anything to do with you.

    It’s worth looking carefully at a bill to determine exactly what was done and who was involvd, then dispute it if you can. The problem is when you’re a patient you aren’t fully aware of all that’s going on (or not going on) around you. Neither is your family because no one is thinking about billing at that time, only that the procedure is successful.

    But as you said, disputing it is difficult under the best of circumstances.

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