Few things are worse than having a serious illness or injury – but the financial aftermath can come close. Receiving a huge bill after medical services when you’re trying to recover only adds to the stress of such a serious event.
Most Americans are confused by medical bills, according to NerdWallet research. What’s more, at least half of medical bills have errors, which only contributes to the confusion.
What few consumers know is that medical bills are always negotiable – it just takes a little time and effort. Negotiating and spotting errors are skills you can learn, but first, you’ll need to be armed with all the proper paperwork. Here’s what you’ll need before you start trying to reduce that medical bill.
Itemized Statement
Most of the time, medical bills come as a summary statement with one lump sum due, rather than as an itemized list of charges. While a summary bill can be much less daunting at first glance than pages of charges, it’s no good to a savvy consumer. To make sure your bill’s charges are correct, you’ll need a statement that lists each drug, procedure and service.
“Make sure you get that itemized statement first thing,” says Beth Morgan, president of Medical Bill Consultants, LLC, who is also known as the Medical Bill Detective. She’s a professional medical billing advocate who helps people save money on health care bills. Most hospital bills show the dates you received care, what the insurance company paid and what you owe, Morgan says, but they often leave out which services you owe for.
“You need a breakdown of that bill before you can do anything with it,” Morgan says. “They’re obligated to give that to you upon request.” Once you have that itemized statement, you can make sure you’re being charged correctly.
Medical Records
Some of the most important reasons to keep your medical records are financial. Because medical bills are created directly from medical records, having them allows you to see what the coding professional used to justify your charges.
“Keeping medical records provides an important window to the past,” says Claire Freeman, lead counselor of Compass Co-Pay, a division of Quality First Medical Billing, Inc. Her organization helps health care providers eliminate errors in billing.
That window should accurately reflect your entire encounter with the hospital or care provider, which levels the playing field. After all, it’s only fair that you should have the same information when reading your bill as the coding staff had when creating it. “As the baseline for all your health care costs, you should always request copies for your files,” Freeman adds.
Insurance Policy
Aside from scrutinizing your bill for accuracy, you’ll want to ensure proper insurance coverage for any medical event. To do this, you need to know the basics of your health insurance policy.
“It’s really worth taking the time to know your plan,” Morgan says. This includes your deductible, co-pays and which services are and are not covered by your plan, she adds.
If you’re not sure where your insurance policy summary is, go online to view it at your insurer’s customer portal. If you can’t find it there, call the insurer’s customer service line. They’re required to provide this document when you sign up for a policy and any other time you request it.
Insurance Explanation of Benefits
The policy is only half of the health insurance documentation you’ll need. You’ll also want to have your explanation of benefits, or EOB, for the medical bill. This document supplied by your health insurer outlines what the charges were and how much the company agreed to pay.
Just as you scrutinize the medical bill to make sure the charges are correct, you should analyze the EOB for proper insurance coverage. “Most patients are intimidated when I first mention auditing an EOB or understanding coding, but patients are ultimately responsible to make sure the billing and coverage is correct,” Freeman says.
Notepad
Armed with these four documents, you can begin to compare them. Now you’ll want to take notes, either on paper or electronically.
Keep track of anything you don’t understand or don’t recall from the medical record, and any charges that don’t line up on the bill. Also record any charges your insurance didn’t cover that you think it should have. Once you’ve compiled your notes, you can look up anything you didn’t understand and move on to checking the bill for errors and negotiating, if necessary.
Remember to keep this note-taking system throughout the negotiation process, Morgan says. “It’s important to keep track of every call you make,” she adds. Note the time and date of the call, the name of the person you spoke to and a call reference number. Follow up every two weeks and stay persistent – you’ll thank yourself for it later.
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Doctor and patient photo via Shutterstock.