Sometimes, we get medical bills for more than we were expecting and it’s easy to get shocked by the huge price tag. Here are five possible mistakes that cause the insurer doesn’t pay the whole bill.
1. The insurance company makes an error or two
Unfortunately, insurance companies are known for their inconsistent information and this applies in all parts of the insurance process. We should protect ourselves by having the good habit of documenting any information, including call reference, date and time we contact the insurance company. So, if anything occurs, we still have a strong leverage to dispute our claim, especially when it’s the fault of the company’s representative. As an example, we could contact the insurer to verify whether a medical provider is in their network. Ignoring this important process could cause us billed for “out of network” services. We should always call the insurer to as how they process the claim and how much the policy will cover the medical service. By having better communication with the insurer, they will be able to catch mistakes and make proper corrections.
2. The medical service provider isn’t in the insurer’s network
Consumer often make mistake by thinking that it’s enough to verify that the doctor will accept the insurance. Unfortunately, this doesn’t always mean that we are entirely covered because these doctors may not be in our network. Ideally, after the appointment, the doctor office will “balance bill” us and we will be charged only the differences between what the insurance pays and what is billed by the doctor.
3. The supposedly “free” annual exam isn’t free
In many services, annual exams are given free. In reality, when we go to a doctor’s office for our free examination, something that is not a part of the standard “free examination” is also performed. This causes the insurer to consider that the exam is no longer coverable. As an example, we inform the doctor during the exam that we have earache, which could cause the doctor to add ear examination to the report. As the result, the “free” annual exam is no longer free. We should check with both the insurer and doctor whether even the smallest addition in the exam is allowed.
4. Insurance company uses the “bundling” method
Insurers use bundling method when secondary procedures are excluded from the covered primary procedures. As an example, when consumers undergo carpal tunnel treatment, the insurer may cover only the actual carpal tunnel treatment, but not the incision or the anaesthetics. This problem should be avoidable by researching billing codes used by the insurer and whether we will get coverage for the entire procedure. Complicated bundling issues could lead to huge bills and this may cause us to seek medical billing advocates to resolve the issue.
5. Missing information
Insurers could request extra information from medical service provider before the pay for the bills. Unfortunately, for an unknown reason, the medical provider doesn’t give complete information or it is lost somewhere inside the insurer’s internal processing system. Consumers should be diligent enough to follow up the process and find things that are not being paid. We should be able to remedy this issue quite easily, by ensuring that the insurer gets correct information.