Northeast Wisconsin
  • Northeast Wisconsin
  • September 2017
Written by 

What am I being charged for?

In an age where the cost of health care is sky rocketing and more and more billing is being computer generated, it is very important to review all your medical charges for accuracy. One of the issues I handle day to day in my practice is incorrect billing. Many issues arise from patients not presenting insurance information at the time of service or having old information. To help avoid headaches and time delays for not only you but your doctor’s office, make sure that you have the correct card in your wallet, all your contact information at the insurance company and doctor’s office is correct, and document when and where you saw your doctor.

A good rule of thumb is you should see an explanation of benefits (EOB) generated by your insurance company within 30 to 45 days. This EOB should mimic the bill you receive from your provider. The EOB is the insurance company’s way of communicating to you how the claim was processed. The EOB should list the full cost of what your provider charged, the contracted discounts agreed on by the provider and insurance company and how they were applied, how the charges were applied to your benefits (see your plan details provided by your insurance policy), and what you should owe to the provider. Taking the time to match up your EOB to your bill can help you detect if something wasn’t charged to the insurance company and that you are paying the correct amount. 

After you have reviewed the bills and EOBs and believe something is incorrect, here are some helpful tips:

Notes: It’s a good idea to record all visits and what they entailed prior to having a billing issue, but especially if you are questioning a bill. From the very first phone call, write down the date, time and the name of the person to whom you speak. It is often hard to reach the same person but good notes have helped me speed along conflict resolution if that is needed later.

Research: Unfortunately, you can’t refuse to pay a medical bill just because it feels excessive to you. You need to know what that procedure might cost at other facilities in the area. Start with an internet price search on a website like HealthcareBluebook.com, which can help you estimate prices for a procedure in your ZIP code.

Request: If you’re questioning hospital charges, you will want to ask for the bill that details every single charge individually, often called a line-item or detailed bill. This bill will show every single thing you have ever received, from every medication to every procedure, large and small. These are usually not sent out anymore and must be requested.

Call: If you’re inquiring about a bill from a physician’s office start with someone in charge of billing who can work on it for you. Usually the person who first picks up the phone doesn’t have the authority to adjust a bill and they may need to go back into your records and have them reviewed. Be persistent as it may take some time, but if you don’t follow up you may be overlooked.

Persistence: After your initial call, put your request in writing and mail it. If you don’t have immediate results with the call and aren’t given a timeline for resolution, follow up. Doing so in writing creates a paper trail and may expedite the issue. 

 

Diane Woodhead

Diane Woodhead is the owner of Woodhead Insurance Services LLC in Green Bay. She believes you deserve a great insurance representative, which is why she chose to become, and will remain, an independent agent. Woodhead Insurance prides itself on being able to explain health insurance in terms you can easily understand. Oh, and by the way, they work on commission so their services cost you nothing! For more information, call 920-544-0058, email [email protected] or visit www.woodheadinsurance.com.

Website: www.woodheadinsurance.com
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