The sticker shock of getting your hospital bill can cause anxiety. This article describes a systematic approach to understanding you medical bill.

1) Make sure charges, insurance payments, patient liabilities, and write-offs match the EOB

The statement of account that your provider sends you should always be validated against the insurance company’s Explanation of Benefits (EOB) for the same service. Reconcile them to make sure that the provider is recognizing the insurance company’s discounts and your patient out-of-pocket liabilities. Charges, payments, write-offs, and patient liabilities are fundamental transaction items that determine your account balance. If there has been a data entry error on either side, it needs to be cleaned up before discussing financial aid.

2) Verify that your deductibles, coinsurance, and copays were applied correctly

On occasion the insurance company may misapply an enrollee’s benefits. This may be the difference between a $25 copay and a $35 copay or the difference between no coinsurance and a 20% coinsurance. If you believe your benefits have been misapplied, you can call the number on your insurance card and ask them to clarify why your benefits do not seem to coincide with your benefit plan. If you have benefits through your employer, a human resource representative at your workplace may be able to help you evaluate the discrepancy.

3) Call you insurance company-have them explain all non-covered services

Finding out that a service you had was not a covered benefit is never fun. If you see this on your EOB or patient statement, you need to ask the insurance call center representative to validate that the service was indeed not a covered benefit and understand why. Does the physician need to prove medical necessity? Was payment for the non-covered service supposively bundled in a payment for a related service? Did the provider perhaps neglect to get pre-authorization or pre-certification?

If you are being personally billed for a non-covered service and the provider is not writing it off, you want to get the insurance company and provider to explain why it was administered to you in the first place.

4) Call the hospital billing department-ask them to explain any disparities

There often seems to be two sides of the story with medical bill errors: the “provider side” and the “insurance side”. Unfortunately, patients are caught in the middle. You need at least one of them to support you when you find a discrepancy so you should talk to both.

Whenever possible, I recommend using a conference call to get an insurance representative and your provider representative on the phone at the same time. This precludes either party from “punting” to the other and forces a resolution to occur.

5) Apply for financial aid with the hospital

After all the factors that determine your account balance been validated, you can discuss financial aid with the provider. Demonstrating financial hardship will usually include filling out a two-page form and attaching copies of your last two pay stubs or possibly your tax return. If you qualify for financial hardship, the provider may decide to adjust your balance based a sliding income scale discount. The closer you are to federal poverty level, the more of a discount you could receive up to a total write-off. I do not condone lying about your situation to try to get a break.

6) After discounts are applied, lock in a payment plan

Arranging a payment plan for the reduced balance will ensure that you can comfortably meet your obligations. You can expect a payment plan for at least four months to up to two years. However, it is very important that you do not miss a payment. If you do miss, the “payment agreement” is breached and the whole amount could come due immediately. Some providers will not even offer a payment plan unless they can automatically debit your bank account or credit card.

Author Bio: Contributed by Nicholas Newsad, M.H.S.A., author of Medical Bill Help and The Medical Bill Survival Guide.

Category: Medical Business
Keywords: medical bills, hospital bills,financial aid,health insurance