Tidbit Tuesdays Tip: ALWAYS check your big bills!

• Check the claim sent to insurance – sometimes it contains errors and is denied for the wrong reasons.
• Check your benefits (all) and out-of-pocket maximum
• Negotiate (especially if out-of-network)

As I mentioned in last week’s blog post, it is important to always call your insurance and clarify why they denied a claim. There are often times when this denial is in error based either on the billing codes or the third party insurance billing company’s error. If the insurance is adamant that they will not pay, there are ways to negotiate with the hospital regarding your bill.

All hospitals have a financial assistance program. Even if you think you do not qualify based on your income, it is still often worth your while to call them and find out. These programs are not based on income, but rather they are based on the ability to repay. This becomes important when you take other debts you have into account. Utilizing the financial assistance program is one way to get the bill reduced. I just recently assisted a client to reduce their ambulance bill in half, simply by calling the company, and asking what they were willing to negotiate – explaining that the client had other medical bills and could not pay this. They agreed to discount it to the Medicare rate, as well as allow them to pay monthly.

If you try to get hospital financial assistance and succeed, you will find that you can make a payment arrangement with them, or even often settle later at a reduced rate. By calling at a later stage and offering a portion of the bill to be settled in full that same day, they may accept that as full payment, because it is more time-consuming for them to take the effort to collect, and it costs them money. And of course, the older the debt is, the more chance you have of negotiating.

The sweet spot for negotiation is between 90 days and six months. This is because most facilities have contracts with different insurance providers, and they can’t really negotiate until the bill is at least 90 days old and at collection status. Once it’s in collection status, they have more leeway to adjust things. The closer it gets to six months, the more willing they are to negotiate because they want to collect something, and they’ve already been carrying it on the books for a long time.

They won’t turn it into collections for six months. There are rules and laws, which say that they have to give ample opportunity for you to work out an agreement before they put it on your credit report. And even then, not saying that you shouldn’t pay your bills, but even then, there are a lot of places that won’t hold it against you if they see some medical billing issues on your credit report. This is because they know that the pricing that hospitals charge are not real prices.

Another point regarding billing is that you need to know what your out-of-pocket maximums are. This is so that you can have the leverage when insurance makes mistakes, or when the billing department makes mistakes. You want to know what those limits are, and you want to know what your network providers are so that you can use the best places for your insurance. And if you find yourself in an emergency situation, seek care at the nearest place. There are tips of the trade to help mitigate those large bills that will come because you used out-of-network services.

If you have any questions please feel free to reach out to me, I am here to help!