Wednesday, January 15, 2014

Managing the Insurance and Medical Expense Maze

Good Morning Cancer Patients and Caregivers:
As you probably already know, reconciling the medical expenses for cancer treatment with your health insurance company is time consuming, frustrating and just plain annoying. Why should anything be so complicated and difficult. The reconciliation effort to determine what expenses you are responsible for after the insurance coverage has been applied is a major undertaking when you are in treatment. In fact, it is equally a major undertaking when you are not in treatment and incurring medical expenses.

Based on our experience working through the maze of charges, deductibles, insurance pay and discounted charges for care, is on set of documentation and record keeping. Not to mention the enormous inaccuracies and errors in charges for medical care reported by the hospital, doctors' offices and any other medical care provider all demanding payment. Meanwhile, you are not necessarily up to your best while going through treatment or recovering from surgery or having other medical procedures being performed.

The process we developed to deal with the maze was a result of necessity. First do not pay the first invoice from the hospital or any medical provider. They have submitted their invoices for payment to the insurance company and are expecting you to cover the remaining cost. We found that if you wait, the insurance company sends you a notice of medical payment and the amount they will cover. You then verify the insurance covered procedures and expenses with the medical providers expenses to determine if they match. If they do not match, you contact the insurance company and medical provider regarding the discrepancies.

We always found numerous errors in the medical providers' expenses for procedures that were not performed and for days we were not at the medical provider. We also found there were expenses that the insurance should and would cover but because they were incorrectly coded by the medical provider, they were not covered by insurance. Numerous other errors and inaccuracies were discovered by comparing the expenses, verifying procedures and dates of service as well as challenging the coding. Many times the insurance company and the medical providers worked the discrepancies out between them and the final expenses we were responsible for were greatly reduced or eliminated.

To get organized, keep a calendar of your medical appointments for treatment and any medical procedures you have. Keep a binder or file to organize the invoices by the insurance carrier and the medical provider by date of service. Review and compare the charges and procedures for accuracy and validate they were performed. Document any discrepancies and contact the company making the error. Document the name of the person, date and phone number of the company representative you spoke with regarding the discrepancy. Make no payment for expenses until the discrepancies are reconciled to your satisfaction and the errors are corrected.

It shouldn't be this tough but the medical payment system and business processes are perfectly designed to make it this tough. So, be patient, don't get frustrated, don't pay the first invoice and be relentless in your efforts to make the provider and the insurance company get it right.

Stay strong, keep your sense of humor and never give up.

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