Joanne’s handy guide to medical billing
First of all: this is NOT about the rights and wrongs of the “Affordable Care Act”, or whatever may (or may not) supersede it. Any comments attempting to politicise this post will end up in the round file. Having said that…..
Staying in hospital or any other inpatient facility is stressful enough. Unfortunately, dear reader, your problems are only just beginning. Just wait until it gets into the whole insurance/billing minefield. Here, I’ll try to provide some info on what you can expect, and how to navigate the muddy waters.
Firstly, while in hospital, you will encounter many people. Doctors, specialists like cardiologists and neurologists, even someone who takes your blood for tests. Many of these people are not in the direct employment of the hospital: they are, in fact, “independent contractors” and as such, they will bill your insurer independently from the hospital and bill you independently from the hospital for your “portion”. Confusing enough? “But Wait! There’s More!”, as they say in the infomercials (side note: why is it ALWAYS $19.99?). But, I digress. Let me illustrate with an example:
A friend spent some time in an inpatient facility. While there, she was seen by their “attending physician”. He billed her insurance, after which she owed about $300. So, he billed her. Only, HE didn’t actually bill her. The bill came from (not the actual name) “XYZ Medical Group”. No mention of the doctor’s name anywhere on the bill. It’s like ordering from Pizza Hut and getting a bill from Domino’s.
So now, you’ve got a bill from an entity you’ve never heard from and/or don’t understand. What to do? Here are my suggestions.
- First of all, CHALLENGE IT. You’re perfectly entitled to do so.
- Your bill may say something like “For Billing Questions, Call (xxx)-xxx-xxxx”. DO NO SUCH THING. Challenge the bill by writing to them. If there isn’t a specific address for correspondence, use either the address for payments or the “return address” on the envelope it came in. In those circumstances, include text in your letter along the lines of “This letter is sent to your address in the absence of a specific address for correspondence”. Consider Certified Mail for proof of delivery in these circumstances. Create your own “paper trail”.
- When you write, make it clear that you will only deal with this matter in writing. What this does is send the message that YOU control and set the agenda. A well-written letter will catch them off-guard and send a message that they’re dealing with someone who’s not going to play their game. Also, don’t include a phone number or e-mail address on your letterhead. Force them to respond in writing.
- A couple of useful phrases are “I do not acknowledge any debt to you at this time” and “This matter is, at the time of writing, IN DISPUTE”. Again, this makes your position clear.
So, what if the bill is clear and indisputable? Many bills may say something like “A payment of less than $50 will not defer any collections activity”. Translation: “So long as you pay us $50/month, we’re happy”. But, they’re not going to say that directly. The prime objective of the medical billing industry is, in my opinion, to obfuscate and confuse the end user. Notwithstanding that, if someone wants to offer me interest-free credit on something I need, I’m not going to turn it down.
One final thought: the politicians are talking about healthcare. They always seem to be talking about healthcare. How about some legislation that compels hospitals and other outpatient facilities to provide, as part of the discharge notes (or weekly for longer stays) a listing of the “independent contractors” who have provided services, including the name(s) they may bill under? Oh wait…..that would actually be useful.
I’ll be writing more on healthcare in the coming weeks and months. Stay tuned 😊