| y"> | | | | your doctor's office and have them intercede in |
| Did you ever receive a medical bill and wonder | | | | your behalf. |
| what it means? Is this Greek? Do you receive bills | | | | Your claim can always be appealed by the |
| even though you have medical insurance? If you | | | | doctor's office and by yourself. |
| want to know how to fight back, read on! | | | | Your claim can always be re-billed if necessary. |
| Welcome to a better understanding of the first | | | | YOUR RESPONSIBILITY: |
| step in the processing of your medical bill. The | | | | (1) co pays |
| charges are entered into the computer. This | | | | (2) non covered services |
| information is then submitted to your insurance | | | | (3) deductibles |
| company by mail or electronically. | | | | All these are listed on your Explanation of |
| This claim form has been sent by your provider, | | | | Benefits. This is the way your insurance company |
| Example: Hospital, doctor's office, x-ray or | | | | pays your claim without any money changing |
| laboratory. | | | | hands. |
| The insurance companies love to send the | | | | Keep all your Explanation of Benefits. Do not be |
| doctor's office or facility complicated Explanation | | | | afraid to call your insurance company. |
| of Benefits. You, as their client, receive the same | | | | If you feel you do not get an adequate |
| copy. | | | | explanation ask to speak with the supervisor. |
| WHAT CAN GO WRONG WHEN YOUR CLAIM | | | | The insurance companies rely on untrained people |
| FORM IS SUBMITTED FOR PAYMENT! | | | | in medical facilities to prepare and submit your |
| (1) Everything | | | | claim form. The insurance companies hope the |
| (2) Your claim form may never get to the | | | | Explanation of benefits will be accepted at face |
| correct insurance company. | | | | value and never challenged. |
| There are many addresses attached to each | | | | PATIENT CONFIDENTIALLY: |
| insurance company. | | | | Be aware of all the changes pertaining to the laws |
| The chances of yours submitted to the correct | | | | of patient confidentially. |
| address is rare. | | | | (1) You can't call a medical facility and expect |
| (3) Your personal information may have been | | | | answers if you are calling about anyone other |
| entered into the computer incorrectly. | | | | than yourself, spouse, or minor child. |
| That is why when you call the insurance company | | | | (2) If you need information about your parents or |
| and you hear say, "we never received the claim | | | | friend, you need a letter signed by that person |
| form from your medical facility", it is probably | | | | filed in the provider's office. |
| true. | | | | Congratulate yourself, you have mastered some |
| FIGHT BACK: | | | | words in Medical Insurance Billing. |
| If you have not received an Explanation of | | | | A little bit of knowledge goes a long way. |
| Benefits from your Insurance Company within 2 | | | | Please let me know if this article is easy to |
| months of your date of service - CALL THEM! | | | | understand. This is a complicated issue which can |
| INFORMATION NEEDED: | | | | lead to you blood pressure rising and steam |
| (1) Your name and the patient's name. | | | | coming out of your ears. |
| (2) Your Identification Number | | | | If you have any questions ASK. Let me hear |
| (3) The date of service (DOS) | | | | your horror stories. Just post a comment on this |
| (4) The name of the facility or doctor where you | | | | article. Feel free to read my other articles. |
| were seen. | | | | Copyright 2005 Linda E. Meckler |
| With this information your insurance company can | | | | REMEMBER: EVERYBODY IS ENTITLED TO |
| give you the history of your bill. | | | | MEDICAL CARE. NOT JUST A FEW. |
| With this information in hand you can then call | | | | |