Monday, April 16, 2012

Patients Pay Things They Shouldn't!

I'm amazed at how often patients will pay a bill they shouldn't pay from their medical provider just because they were billed. It happens more often than you think and by people that come from all walks of life, including the highly educated.

So how does this happen? While the process is somewhat easy to define, the attitudes that allow it to happen are not.

I'd like to talk about process first as the big assumption is that doctor's bill their patients erroneously in error to make money. That's just not the case the large majority of the time.

When an insurance company pays a claim, they will send a detail of the payment called an EOB or EOP -- Explanation Of Benefits or Explanation of Payment. Most of the times, there will be several hundred claims included in one EOB. The lists of charges, write offs, payments, and patient responsibility will be in column format. Each insurance company uses their own format and wording so it's difficult to get in a routine for posting payments when they're all different.

Sometimes what happens is that a poster will post the write off as the patient responsibility leaving a balance that is higher than what the true patient responsibility is. Other times it may be a simple transposition of numbers. Either of these can result in an incorrect balance that's billed to the patient in error.

When you're trying to work though hundreds of claims in a day and trying to follow the different formats, keying errors such as these are likely to happen. It's just a fact of a asystem that is set up to handle a massive amounts of information that flows back and forth.

Some offices may have software in place to catch errors such as this, however when the main focus is bringing money in and keeping your head above water, posting errors often fall to the wayside and are put on the back burner. They're just not a high prority when insurance companies have deadlines.

Most of the time, patients will pay without questioning because they just don't want the hassle of having to pull out their insurance paperwork and compare it to the statement. Besides, it's confusing!They figure that the provider's office is on top of what they should be billed. This is just simply not true and the result is that patients often pay for things they shouldn't.

So how do you avoid paying for something that you should be? First of all, no one has more time to look after your pocketbook than you do. Yes, it requires some effort on your behalf but it's your money so invest the time.

Be sure to keep your Insurance EOB's so that you can compare your medical provider's bill to what your EOB is stating you owe. Verify that the charges and the write offs are the same as well as the amount that the insurance company states you owe. The statement from your doctor should mirror your EOB.

If you see any discrepancies, call the doctor's billing office and ask them to review your account. Have your EOB and bill in hand along with a calculator. The call will go much smoother if you have the information to help the billing staff find your account easily. When explaining your reason for calling, be brief but specific about the issue and how you think the error occurred.

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