Medical billing errors

gingersnapwolves:

yumearashi:

Had something happen the other day, I thought I’d bring this PSA back.

I just got a pair of medical bills totaling $700.  The things is, neither of them were correct.

My primary care doctor never even sent the claim to the insurance, they straight up
billed me the full charge out of pocket, and couldn’t even explain why when I called them – they had my insurance on file and everything.

My dentist sent me a bill
without processing the insurance’s response to the claim –  they told me that they didn’t receive it until after they sent me the bill, but the
date on the insurance’s decision was a full month before the date on the dentist’s bill, so I’m thinking that was a big fat lie. 

What did I actually owe, after calling and getting all this sorted
out?  $29.75.

Now, I spent 8 years doing medical billing, I have the experience to look at these bills and explanation-of-benefits letters and know that what I’m being charged isn’t correct.  What really appalls me is
knowing that most people in this situation wouldn’t know that this wasn’t legit, and would probably just
pay up – or end up in collections when they can’t.

The truth is, most medical billing in the US today is outsourced to medical billing companies – doctors’ offices and even hospitals don’t always have the manpower needed for the lengthy, complicated, difficult and time-consuming process of medical billing.  And a lot of these companies are poorly run and staffed by employees with minimal training who don’t know anything about the doctors or procedures or patients they’re billing for – meaning lots of errors.  Additionally, these companies operate on a profit model that demands maximum payment for minimum effort – if it’s not easy money, then it’s not worth their time.  They submit the simplest claims possible, and if they get paid, great – if not, then they mark the claim denied, assign financial responsibility to the patient, and move on to the next.  Chances are, they’re not going to contact the insurance company and find out why it was denied, much less revise and resubmit the claim, or file an appeal. 

If you get a medical bill that seems high, call the provider who sent the bill and tell them exactly that.  Ask them to please take a look at it and see if there were any issues.  Ask them to explain it to you.  Ask them about the insurance’s decision.  Have them walk you through it until you feel comfortable.  If you have to, call the insurance company to ask why they decided the claim the way they did. (always, always, ALWAYS be polite!)  It won’t always help – sometimes they’ll bullshit you, and sometimes medical bills are just high.  But you can at least ask whether every effort has been made to get you covered.

things I have seen in my job at a medical billing company just in the past few weeks:

• someone who was charged an additional $25 copay because their insurance incorrectly processed a claim as if the provider was out of network
• someone whose insurance denied their claim stating they weren’t enrolled, despite paying another claim on the exact same date of service
• someone who got a bill for $400 because the scan of their insurance card was blurry and we had a P where an F should have gone in the ID
• someone who got a bill because their insurance requested more information and our dumbass software took a zero payment from the insurance to mean “oop, guess this is the patient’s responsibility!” yeah it wasn’t
• someone whose claim got denied by insurance because “smoking cessation counseling” is a male-specific procedure (?!?!? still haven’t figured out what happened there; apparently it’s the insurance who needs to stop smoking whatever it is they’re smoking)
• someone who got a bill for $800 because we billed their claim to Tricare *north* instead of Tricare *east*

There are so many dumb reasons your bill can get fucked up, guys, believe me because I see it every day. A legitimate company will never have a problem going over the charges with you and checking for errors. 

Worth noting – two of those people came within inches of going to collections because they received three bills but never called us to see what was up. Only a last minute check before it got sent out prevented that – and most companies don’t have the manpower to do those last minute checks. Hell my company doesn’t have the manpower but I do it every month anyway because I know exactly how often we fuck up. If you get a bill you think you shouldn’t be getting, please don’t just ignore it. Even if you call and they say “yes, that’s exactly what you owe and here’s why”, you haven’t lost anything.

Medical billing is stupid, friends. Protect yourselves.