You visited your doctor or dentist last month, paid your co-pay and assumed your health insurance would take care of the rest. But today there's a bill in your mailbox and/or an explanation of benefits, or EOB, from your insurance company making it clear you owe money.
"Some people assume they have to pay the bill," says Erin Moaratty, chief special projects officer for the Patient Advocate Foundation, a nonprofit that helps patients negotiate the system. "A lot of the fear is of collection agencies. They're not going to send your bill to collections right away." And once you overpay, it's often tough and time-consuming to get a refund, she says.
So keep your checkbook in your pocket -- at least for now. We have solutions for five billing problems.
Problem No. 1: You get a bill from your medical provider's office for a procedure or service that your health insurance has covered in the past. Patience pays off here. The medical office's billing cycle might be ahead of your insurance company's claims processors. "Maybe the office has submitted the claim to your insurer and the insurer hasn't paid yet," Moaratty says.
Solution: Allow 30 days to make sure your health insurance company has time to process the claim, Moaratty says. Call the provider and the insurance company to follow up if needed.
Problem No. 2: You have a big pile of EOBs and medical bills, and it's hard to tell what or whom you owe. That disorganization can cost you time, frustration and money.
Solution: When you get a bill from your medical provider, staple it to the EOB. "We recommend keeping a folder, a stapler and a highlighter to organize and mark your bills," Moaratty says. When you call your medical provider and insurance company with questions, write on the bill or the EOB the date, whom you spoke to and what the issue was.
Problem No. 3: Your claim, usually paid, comes back this time stamped DENIED. Don't panic. Your medical provider may have simply incorrectly coded the procedure or treatment.
Solution: Call the insurer, ask what the proper coding is and make sure the code matches the service you received, she says.
Problem No. 4: Your claim was paid but for only a fraction of the medical service you thought was all or mostly covered. You may have seen an out-of-network provider. "You're going to have larger out-of-pocket costs if you don't use your contracted providers," Moaratty says. For example, the procedure costs $100, your insurer is willing to pay $60, and you're supposed to pay 20 percent. If you see an in-network medical provider, the provider usually agrees to write off the difference between the $100 cost and the $60 your insurance pays. An out-of-network provider does not have to write off that difference, so you'll pay more.
Solution: You may have to pay this claim. For the future, make sure you're seeing a provider who is in your network.