With ample opportunities for billing errors within today's complex health care claims and reimbursements systems, it's a wonder people carrying individual medical insurance don't spend more time carefully checking each Explanation of Benefit (EOB). The EOB shows what was charged less what the insurer agreed to cover, the balance being what you owe. Checking your EOB is the first line of defense against overpaying on a health insurance claim.
Your EOB may not reveal a lot, but you can check to see that your name, address, and policy information are correct. You should also confirm that you were charged the "allowable" rate set by your insurer and not a penny more. Deductibles can be as high as $10,000, and payment comes entirely from your bank account, which makes group discounts all the more important.
Other common errors the EOB may reveal include: Failing to get credit for a deductible that has been paid, in-network providers classified as out-of-network, legitimate claims denied as "medically unnecessary," "upcoding" (being charged for more expensive services than you received), and "unbundling" (when a single procedure is broken down and billed as many). At Blue Cross/Blue Shield's Web site www.bcbs.com/betterknowledge/anti-fraud/explanation-of-benefits.html, there's a brief tutorial on how to read and double-check an EOB.
According to a 2001 Harvard study, illness and its associated costs are responsible for 50 percent of all bankruptcies, so it literally pays to request itemized bills from hospitals and other service providers. They are your next line of self-defense against overpayment. The problem is making sense of them, which may require hiring a patient advocate.
Lee Taber works for HealthCare Mediation Group auditing itemized bills, coordinating appeals, and, when possible, negotiating reduced payments and workable payment schedules to keep clients from getting a damaging credit rating. While costly mistakes are rare, Taber estimates that 40 to 50 percent of hospital bills contain errors: "The potential for error is high when a bill is 15 pages long and lists every aspirin and other medical supply."
Advocates receive a percentage of the money they save you. Their cut varies but can run as high as 30 percent. He concisely sums up the benefit of working with an advocate: "If you don't know what you're looking for, how would you find it?"
Indeed, visit the Individual Services page at Medical Billing Advocates of America at www.billadvocates.com/ where you can read about a patient who was charged $12 for a "mucus recovery system" —a box of tissues.
If paying someone to fix a mess you didn't make gets you mad, imagine being the victim of medical identity theft. It's like losing control of your social security number and private financial info, but this is a loss that can be deadly. If a phony claim is made using your benefits, your chart could contain wrong information when you need urgent care. If your benefits are tapped out by an impostor, you'll have none left for your own care. According to a World Privacy Forum report on the crime, all levels of the medical system may be involved, in addition to organized crime.
When it comes to your individual medical insurance, do your homework and prepare in the event of inflated bills or medical identity theft. It can save your money and your life.
An ounce of prevention.
One of the most effective ways to lower medical expenses, especially over the long haul, is to maintain a healthy lifestyle by: - Taking advantage of wellness programs - Maintaining a healthy weight - Exercising regularly - Kicking unhealthy habits (e.g., smoking) - Getting regular checkups.
Look for the freebies.
If your health insurance provides little to no coverage in certain areas, or if you lack health insurance coverage, look into free health screenings. Local clinics and hospitals often offer a variety of screenings, such as blood pressure, cholesterol, and mammograms. If it's free, don't hesitate to take advantage of it!
Prescriptions on the cheap.
If you take prescription drugs regularly, they can cost you plenty. But it's not hard to find ways to save money. For example, order your prescriptions through the mail, through a traditional or online pharmacy. If you belong to a prescription drug plan through your health insurance, you can probably get a three-month supply through the mail for the same price as a one-month supply at the local pharmacy. And if possible, ask your pharmacist or doctor to prescribe a less-expensive generic drug.
Keep an eye on your bills.
Medical bills can be confusing, but taking some time to review the charges may save you money. Make sure your bill accurately reflects the procedures you underwent and applies the proper insurance coverage you may have. It's not too uncommon to have wrong computer codes where you're billed for health care you never received. Contact the company's billing office immediately if you find a mistake.
Togetherness can save money.
A number of married couples keep separate health insurance coverage even though it may cost them more to do so. Take a look at both your and your spouse's coverage and see if it makes sense for either of you to join the other's plan. Be aware that most plans allow the addition of a spouse within a certain time period after getting married for example, 30 days. If that's the case, you may have to wait for the plan's annual open enrollment period.
Keep track of it.
With tax time right around the corner, you may be able to deduct certain medical expenses if you itemize. In order to itemize, your total medical expenses need to exceed 7.5 percent of your adjusted gross income. The allowable medical expenses include everything from health-care services to medical aids, which include eyeglasses, hearing aids, etc. Keep records of these expenses if you think you'll be able to deduct them for the tax year.
It doesn't hurt to haggle.
Many people don't realize that they can sometimes negotiate to lower their medical bills. It may not always work, but it doesn't hurt to ask your doctor, hospital, or pharmacy if they're willing bargain with you. Before you start negotiations, do some research on what other health-care providers in your area are charging. In addition, your health-care provider may lower their price if you pay in cash up front.
Save a little for a rainy day.
If your employer offers a flexible spending plan that allows you to put pretax dollars in an account, jump on it. With a flexible spending plan, you'll be reimbursed for out-of-pocket medical expenses, such as prescription drugs, dental care, and co-payments. And because flexible spending contributions are taken out of your pay before taxes are calculated, you use pretax dollars to pay your medical bills.
Know who's covering you.
These days, insurance companies often provide benefits designed to help you stay safe and healthy. One example - you may be able to receive discounts on vitamins, alternative medicines, health club memberships, or bike helmets. Also examine the range of coverage your health plan offers. It may cover dental care for young children, chiropractic care, and acupuncture. Read all materials provided by your insurer thoroughly to find out what products and services are available before you pay them out of pocket.
It's your money, shop around.
If your employer doesn't provide health insurance, you may have to obtain your own coverage. In order to get good coverage at an affordable price, you'll need to shop around. Premiums vary widely, so you can save some cash if you get quotes from several companies. Examine each plan's coverage and features, and take into account all exclusions, limitations, and the freedom to choose health-care providers. It's also important to find out how much your out-of-pocket expenses will be as far as co-payments, coinsurance, and deductibles are considered. Be careful. With some plans, small amounts of money can add up quickly with frequent visits to your doctor.
Both Ryan Patterson & Pat Carpenter are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Ryan Patterson has sinced written about articles on various topics from Auto Insurance, Medical Insurance and Auto Insurance. Ryan Patterson is president of US Insurance Online based in Austin, TX. He graduated in 2000 from the University of Texas with a combined business and computer science degree, and started the company in May of 2005 with fellow entrepreneur Jim Waltrip. Th. Ryan Patterson's top article generates over 12100 views. to your Favourites.
Pat Carpenter has sinced written about articles on various topics from Women, Marathon Tips and Insurance. Pat Carpenter writes for Precedent Insurance Company. Precedent puts a new spin on health insurance. Learn more at . Pat Carpenter's top article generates over 823000 views. to your Favourites.