Updated: Jun 13, 2021
Medical bills and insurance plans can be incredibly difficult to understand. Know your options and rights.
As most of you know, it is often incredibly difficult to understand your medical bills or your health insurance plan. And if you happen to be one of the brave and patient souls willing to sit on hold and call your insurance company, you will often get a different answer from the customer service representative to your question each time you call.
I worked in executive operations roles in the disability and medical insurance industries for most of my career and wanted to provide four tips to help you from overpaying your medical bills.
Call your health plan and ask them to explain your bill. When you call, be assertive but polite to your customer service rep. Remember your customer service representatives were probably thrown into their roles with limited training, so being nice will go a long way in helping you resolve your issue. They are human and will want to help you with your issue if you show them respect. Many insurance companies have also sent most of their service operations offshore to India or the Philippines to help them decrease expenses. Staff turnover with these offshore sites is extremely high. Ask to speak to the supervisor if you feel you are not getting anywhere with your representative. I recently escalated an issue to a supervisor with my health plan after it was clear to me that my representative had no idea what procedures were covered at no charge under the Accountable Care Act (ACA).
Call your insurance company the week before your scheduled visit or procedure to make sure they are still contracted with your provider. Many insurance companies will terminate their contract with your provider without your provider knowing it, or within days after your insurance company told you they are contracted with your provider. I recently scheduled a mammogram with a provider who was in network with my insurance company at that time I called, but I found out three weeks later and the day before my mammogram that my provider was no longer “in network’ or contracted with my insurance company. Fortunately, I was able to schedule my mammogram with another provider that was contracted with my insurance company and avoided receiving an exorbitant out of network bill from my previous provider.
Assume your bill is wrong. It is estimated that over 80% of medical bills are wrong due to the complexity of provider contracting, and the complexity of claims examiner’s jobs, which often requires that they navigate through numerous antiquated systems to pay a claim. Contact your human resources manager to explain your coverage before you pay a bill.
The amount of your bill can can be negotiated. If after contacting your human resources department, you are sure you owe the amount on your bill but cannot afford it, negotiate with your provider to come up with a payment plan. Most providers will allow this. If you cannot pay anything, ask them to write off your charges under “Charity Care”. Your provider will send you a form to fill out asking you to list your income and expenses before they agree to write off your charges. Your providers do not want to negatively impact your credit and would rather work with you to come up with a payment plan or will agree to completely write off your charges if you provide them with proof of your inability to pay.
If you are still struggling to understand your medical bill, consider contacting Patientadvocate.org to help you better understand your rights and what you owe.