Medical bills give you a headache?

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Medical bills give you a headache? Here's relief By Flagg Godbey

If you can't decipher your medical bills, think a charge isn't quite

right or notice you've been billed for treatments you never received,

you're not alone. In one survey of more than 10,000 Americans, one in

20 said they had found serious mistakes when they looked closely at

their hospital bills. In another study, an irate 60 percent said they

had been surprised by charges they had expected their health insurance

plans to cover.

" Straightening out medical bill problems is a huge challenge,

especially if you're ill or taking care of someone who is, " says

Norris, president of the Association of Claims Assistance

Professionals and owner of the Torrance, Calif.-based ClaimCare service.

" Millions of pieces of paper show up in your mailbox. It's tempting to

ignore them or just to pay every single one, especially when you don't

have the time or emotional re-sources or the knowledge base to battle

all of the Byzantine rules and regulations, " says Norris.

Here's how you can resolve a medical bill dispute — or avoid one in

the first place.

Q I just received a bill for a minor medical treatment that seems

exorbitant. Should I just pay it?

A No. It could be a mistake. Call your insurance company and your

doctor's billing department and explain the bill doesn't look right.

Tell the insurance company what your diagnosis and treatment were and

ask if the codes on the bill match those. Ask for a copy of the

explanation of benefits notice for

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the bill to see what was covered and what wasn't.

Question everything that wasn't covered — you may find the problem there.

Ask your medical provider for an itemized bill to see if there were

obvious charges for things you didn't receive or shouldn't be billed

for, such as procedures or treatments you didn't get or even small

items, such as tissues or hand lotion, during a hospital stay.

Q What should I do about an enormous medical bill that I can't afford?

A First, keep talking with the hospital or medical practice that's

billing you. Ignoring a bill won't help; it could be passed quickly to

a collection agency. If it already has been, call the collection

agency immediately and tell them the bill is in dispute. This should

give you a longer deadline so you can figure out what to do.

Second, gather all of your bills and the explanation of benefits

notices from your insurance company. It's quite possible there are

errors and you don't owe as much as you're being billed. The error

could be as small as an incorrect diagnosis code, incorrect insurance

information or charges for services you didn't receive. If the bills

are confusing, ask a friend or relative to review them with you.

If you're sure the bill is completely correct, talk to the hospital or

medical practice about a payment plan you can afford.

Q I'm trying to get to the bottom of a problem with the medical bills

of an ill relative, and I'm overwhelmed. Is there someone I can hire

to help me?

A Yes. You can find a medical claims consultant through the

Association of Claims Assistance Professionals (ACAP) at claims.org or

Medical Billing Advocates of America at billadvocates.com.

Consultants charge $40 to $125 an hour or get a percentage of

recovered insurance compensation. They can cut through the chaos of

health care paperwork — organizing bills, filing claims, disputing

denials and looking for mistakes. It may be worth consulting one if

you owe more than a few hundred dollars and aren't getting anywhere on

your own.

Q Is there some way to avoid billing problems in the first place?

A Yes. First, know as much as possible about what will be covered by

your health insurance. If you're choosing a new doctor, call your

insurance company to be sure the doctor is in its provider network so

you get the best coverage. If you're going to your doctor, a hospital

or a clinic for anything beyond a routine visit, call your insurance

company first to see if you need a preauthorization for a procedure or

treatment. Ask your doctor to estimate treatment costs, too.

Second, keep good records. When you receive a medical bill, don't pay

it until you receive the explanation of benefits notice from your

insurance company. This shows what your provider has billed, what the

insurance company will pay and the amount you're supposed to pay. Read

them both to be sure there are no mistakes.

Third, stay on top of insurance claims. More and more providers don't

file them for patients, so it's up to you. And if you're covered by

two health insurance plans, don't assume anyone will bill the second

one; usually, you have to do that.

This column is written by Flagg Godbey and the editors of Better

Health & Living.

http://www.twincities.com/health/ci_9752901