How to Spot Medical Billing Errors and Reduce Out-of-Pocket Expenses

September 11, 2020

You may find yourself accruing a lot of out-of-pocket (OOP) costs not covered by Medicare that can become a major financial burden. Healthcare costs are exorbitant but there are some steps that caregivers for seniors can take to reduce these out-of-pocket expenses.

The first step is to make sure you understand the invoice and the insurance company's Explanation of Benefits (EOB). Your medical provider will send you a bill explaining what you need to pay, while your insurance company sends you an Explanation of Benefits explaining why you need to pay that particular amount. The EOB will show the lower contracted rate for an in-network provider and it will show how much your policy is willing to pay versus the patient's responsibility. It is important to do your research on in-network providers prior to major surgery or treatment so that you can select a good quality healthcare provider while making sure that decision is also cost-effective.

Do not pay the medical bill immediately upon receipt. You need to take the time to determine the amount that you truly owe. Make sure you have an EOB for that bill before making a payment. If you have not received an EOB, typically that means your insurance company has not finished processing the claim. Compare the EOB and the medical bill. Request an itemized bill from your provider if they do not provide you with one. Go through the itemized bill to make sure you did indeed receive the services for which you are being charged and make sure there are no duplicate charges. If the itemized statement includes medical billing abbreviations that you do not understand, call the provider for clarification.

Before paying the bill, contact the provider and ask if they have any flexible payment options or discounted rates if you pay upfront. If you do not have health insurance, many providers will give you a discount to bring your bill closer to the contracted rate that they have established with their accepted insurance companies.

If you feel overwhelmed or lack the confidence you need to handle the matter on your own, you can seek out a medical bill advocate. The Patient Advocate Foundation helps patients with serious medical issues so they can receive the treatment and medical coverage they deserve, often at no cost. You can also hire a professional medical billing advocate and the fee is typically on a contingency method where they are paid a percentage of the total amount they negotiate off the medical bill. If the advocate cannot secure a reduction in the amount owed then the client may be required to pay a retainer fee.

Failing to pay medical bills will very likely affect your credit. It is important that you address these invoices and make arrangements for payment in a timely manner. The longer you wait to handle these issues the more complicated and costly the process is likely to become.

At Stouffer Legal in the greater Baltimore area, our Elder Law attorneys work closely with our senior clients and their caregivers to ensure they are treated fairly and not placed at a disadvantage due to medical billing errors. Contact us for more information.

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