JLS (jlsjlsjls) wrote,

U.S. medical billing in a nutshell

libwitch wrote an excellent post about handling medical bills/insurance yesterday ... the original post is privated, but she gave me permission to quote the rules portion here for the benefit of my own American friends. Hopefully this info will help make life a little easier (and a little less expensive).

The second money pit is obviously...this. Mom, luckily, had insurance. Unfortunately, as with all major medical issues, her journey involved apparently 500 different medical units who all want to bill her. This is what we have learned.

1. Don't pay anything until all explanation of benefits/statements (whatever your insurance calls them) comes in. This can take a few months. So its painful, because you may get more and more demanding bills from medical folks. But remember - its very hard to get your money back once its been paid.

2. Once you are reasonably certain all the above has came in, start matching up the bills with the explanation of benefits. What is easiest to do is to do it by amount, date of service and provider.

3. Set aside any bill that does not match up to the *penny* with the statement from your insurance company. And start calling the medical providers.

These are the sort of questions you are going to ask:
1. What exactly am I being billed for here? (procedures)
2. What services/providers are included in this bill?
3. Did my insurance company pay anything on this statement?
4. Then, if necessary, you call your doctors and ask them if they billed the hospital for anything.
5. Lastly, you call the insurance company to confirm anything that was said.

This is why you do this:
Doctors will frequently bill the hospital for services provided. They will also bill YOU for the services they provided the hospital and send the same statement to the insurance company. They will then wait to see who pays it first.

They will not, however, tell you if anyone else pays them.

So if you just start going through and pay the amount on the bills, you can end up paying for services that someone else already paid - probably your insurance company - to either the hospital OR to the doctors.

We know this. We had the same conversation with 4 different doctors from 4 different medical groups.

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