Finance > Insurance > Horrifying! Medical Bills! When You Have Medical Insurance/Fight Back
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Article rating : 0.00, 0 votes. Author : Linda Meckler
Welcome to a better understanding of the first step in the processing of your medical bill.
The information On Your Claim Form That is Submitted To Your Insurance Company from your provider (doctor or facility) Example: Hospital
1. The Patient's name.
2. Patient's date of birth. (DOB)
3. Date of service (DOS) The day you were seen.
4. The patient's identification number (the number on your insurance card.)
5. The name of the Guarantor (name of person insured).
Example: Spouse
6. All doctors have a computer generated identification number as well as the facility itself having its ownnumber. (Doctor's office or hospital)
7. The reason for your visit. Example: Doctor's visit which will have its own independent CPT code. Remember each procdure the doctor performs has its own separate CPT code and with a dollar value assigned to the CPT code.
8. Your diagnosis is assigned a (ICD code.) If you have three different problems each will be assigned a separate ICD code.
9. The contractural (dollar amount) adjustment your doctor or facility has established with your insurance company. It means, that less money for you to pay in the long run.
10. Place of Service (POS) This is where you were seen.--- Example: A doctor's office, hospital, or laboratory.
11. The referral number is assigned to you for your medical visit by the insurance company. This number or referral paper allows you to be seen by your doctor.
12. The authorization number is assigned to you to receive treatment. Example: An x-ray. It's a number or paper from your insurance company for you to receive treatment.
13. If medical records are needed by the insurance company they are attached to the paper claim.
14. The name and address of your medical insurance company.
---Explanation OF Benefits (EOB)---
What do you do when you receive your Explanation of Benefits from your Medical Insurance Company.
The insurance companies love to send the doctor's office or facility complicated Explantion of Benefits. You, as their client, receive the same copy.
---What Can Go Wrong When Your Claim Form Is Submitted For Payment To Your Medical Insurance Company---!
Everything! First of all your claim form may never get to the correct insurance company. There are many addresses attached to each insurance company. The chances of yours submitted to the correct address is rare. That is why when you call the insurance company and they say, we never received the claim form from your medical facility, it is probably true.
In the 14 steps above some of the information could have been incorrectly keyed into the computer. Therefore, your claim will be denied.
Fight Back:
If you feel you should have received an Explanation of Benefits from your Insurance Company within 2 months of your date of service and haven't. Call them. The information you need to give is:
(1) Your name and the patient's name.
(2) Your Identification Number
(3) The date of service (DOS)
(4) The name of the facility or doctor where you were seen.
With this information your insurance company can give you the history of your bill. With this information in hand you can then call your doctor's office and have them intercede in your behalf.
Your claim can always be appealed by the doctor's office and by yourself.
Don't forget their are copays, non covered services,and deductibles. All these are listed on your Explanation of Benefits. This is the way your insurance company can say they paid your claim without any money changing hands.
Keep all your Explanation of Benefits. Do not be afraid to call your insurance company---. If you feel you do not get an adequate explanation ask to speak with the supervisor.
Always be courteous when speaking to any person about your bill on the phone or in person. You can win more points with honey then with venom.
I can personally say, that when a patient called me on the phone and was nice, even though they were upset about their bill, I would try everything I could to help the person. But if they were nasty and out of control all I wanted to do was get off the phone as soon as possible.
The insurance companies rely on untrained people in medical facilities to prepare and submit your claim form. The insurance companies hope the Explantion of Benefits will be accepted at face value and never challenged.
I would like to say that because of the change of the laws in patient confidentially, you can't call a medical facilty and receive information about Example: Your parents without their consent in writing. Be prepared for this. If you need to call about family members or friends medical bills or other problems, make sure you have a letter from the person you represent with their signature.
Congratulate yourself, you have now mastered a few words used in Medical Insurance Billing. A little bit of knowledge goes a long way.
Please let me know if this article is easy to understand. This is a complicated matter. It can lead to your blood pressure rising and steam coming out of your ears. If you have any questions. ---Ask---
Let me hear some of your horror stories. Just make a comment at the top of the page.
Copyright 2005
Linda has worked in the above field for many years. Now her love is writing. Her first book published is "Ghost Kids Trilogy." Three complete books in one. The first of its kind adventure childrens book. Love, Family Values, and Charity burst off the pages. For children ages 8-12. Book (1) Ghost Kids: Two real children team up with
two Ghost Kids. They want to be reunited with their parents. Book (2) Blue Vase Mystery: Uncle Charlie the villain of the book wants out of the Blue Vase. In return he will tell the real children where the Pirates' Treasure is hidden. Book (3) Pirates' Treasure-the hunt: Take the exciting trip hunting for Pirate's Treasure. Order at http://www.buybooksontheweb.com and http://www.amazon.com ISBN 0-7414-2273-5. Website http://members.cox.net/ghostkids Order 5 books +40% discount. An order of 20 or more no Shipping and handling.
lmecky@tns.net
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