Your "amount due" may be what you actually owe, but not necessarily what you alone should be responsible to pay. In other words, physicians and hospitals often bill the patient before the insurance covers their amount. Here's some tips to maybe save you money in the bill paying process.
- Never pay before the insurance pays and you have an explanation of benefits (EOB). The EOB should tell you the charges, amount approved by the insurance company, the amount paid and how much you owe. Don't worry about your doctor getting angry if you don't pay the bill as soon as it is received. They're not exactly hurting financially.
- Always ask your physician if they file to insurance. It's often their responsibility to file the necessary paperwork in advance of receiving payment if they accept the assignment from the insurance company. By accepting the assignment, the doctor agrees to accept, as payment in full, what the insurance company approves. He/she must write-off the difference between the approved amount and the charged amount.
- Doctors may charge you a co-insurance payment upfront upon all visits. If your doctor is in the network, which usually means he accepts assignment, ask that you get billed for the co-pay after insurance has been filed and reimbursement received. A common occurrence is that you may be asked to pay your co-insurance (20%) based on the full charge, as opposed to the approved amount. If you are paying a co-insurance at the time of your visit, make certain that it is based on the approved amount. If not, you will overpay and may not get a refund if you and/or the doctor's office do not realize the error.
- Just because you're being charged a number that your insurance does not fully approve does not necessarily mean you're responsible for the difference. Sometimes, providers are willing to accept the insurance's allowed amount even if they don't accept the assignment. It's in your best interest to at least ask if they're willing to make the adjustment.
- Anytime an insurance denies coverage or a charge, question it. They may turn out to be correct, but just as often, the provider miscoded the claim or wrote the wrong diagnosis for insurance purposes.
- After you finally pay a bill, make sure you document it in terms of amount paid and method of payment (check, credit card, etc.). This is extremely important in the event you receive a duplicate bill later.
Following these tips will not be the cure for all your ills, but they will certainly protect your financial health.
- The Patient's Advocate