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        4 min read

        Why It’s Critical To Have Medical Bills Reviewed

        Why It’s Critical To Have Medical Bills Reviewed

        It may feel like second nature to review your cell phone, credit card, and internet bill for mistakes. Reviewing your medical bill, however, often feels like a near-impossible task. They are notoriously indecipherable and written with confusing codes, leaving you unsure of what you’re being charged for, how much is due, and where to get help. Even though you’re well aware of today’s inflated medical prices, trying to double-check your bill can be so confusing that it’s easier to pay the charges as long as they’re not grossly unreasonable. By doing so, however, you’re highly likely to be paying for services you never used, visits you never had, and many other flukes. The vast majority of medical bills contain some errors, deeming having medical bills reviewing a necessary step for all patients. Although there hasn’t been a comprehensive study on medical bills, Professor Stephen Parente, of the University of Minnesota has studied medical billing and estimates that 30% to 40% of bills contain errors.

        What’s Wrong With Healthcare Billing?

        Because of the variation in healthcare coverage between different insurance carriers, there is no such thing as a typical medical bill. For this reason, medical bill errors are not systematic or predictable. They may occur as duplicate charges, charges for canceled procedures, balance billing, and upcoding, where they charge you for a more serious/costly procedure than the one you received. All of these are due to the complex coding system that is used by providers to classify diseases and procedures. This code makes it easy to make mistakes, miscommunicate, and end up inputting a code for a more expensive procedure.

        Still, other issues arise from purely administrative errors, like having typos or incorrect patient information or sending the bill to the wrong insurance company. Both can result in insurance companies rejecting the claim, leaving employees with an unaffordable bill. We see these issues every day.

        Luckily, there is a foolproof remedy to combat these types of costly mistakes. The easiest way to protect employees and their wallets from inaccurate medical charges are to have a service that reviews and negotiates bills on their behalf. Sure, you can teach employees how to search for billing errors on their own, but the process is so tedious and time-consuming that it would undoubtedly lower their productivity at work. Most people prioritize health and wellness over their job, thus securing employee’s healthcare services and costs is a necessary precursor to maintaining fully engaged workers. There are countless advantages offered by a medical bill review service– ROI and peace of mind are just the beginning.

        Negotiating out-of-network fees

        It’s a common practice for insurance carriers to perform “backroom deals” with particular doctors and hospitals to negotiate favorable rates in return for directing patients to their services. What results is a configuration of “in-network” and “out-of-network” providers, unique to each insurance carrier. Receiving care from an out-of-network provider comes with costly financial consequences since insurance carriers are trying to make it as hard as possible for patients to leave the network.

        If you’ve seen a doctor that happens to be out of your insurer’s network, then you’ll most likely find yourself with a ridiculously steep medical bill. Luckily, the story doesn’t have to end there. Outrageous out-of-network fees can be negotiated down to reasonable levels. Many providers expect that their fees will be discounted and negotiated, so it is up to the consumer and the bill review service to do act on a bill that is higher than expected. Medicare payouts provide a baseline that can be a starting point in negotiations since they are public and widely accepted – even by the provider doing the billing sometimes.

        A bill review service can help you do so by making a convincing argument for your case to be paid at an in-network rate. Health plans are open to negotiation, but the reality of this process is that it’s time-consuming and involves phone calls, emails, and letters to be sent back and forth with the carrier. It is much easier to leave this process to a team of experts, who have the experience and know-how that is necessary for working with medical providers and carriers to achieve various discounts and deals within a contract.

        Room for Negotiation

        An advocacy service can use several strategies to negotiate to pay for out-of-network care at in-network rates. First, they can discuss a patient’s cost-sharing, which includes their deductible and coinsurance rates. Deductibles are usually higher for out-of-network care. Besides, the money you contributed to an in-network deductible may not count towards the out-of-network deductible, meaning you have to start from scratch when purchasing care from an out-of-network provider. Negotiating to pay for care at in-network deductible and coinsurance rates can, therefore, contain costs significantly.

        Secondly, they can challenge “balance billing” practices, which many health plan contracts prohibit. Balance billing is when a medical provider bills you for charges that your insurance carrier did not cover. This often occurs because the price for a procedure surpasses what insurance carriers deem reasonable and customary for that given procedure. Because of carriers’ refusal to pay bills exceeding a certain amount, patients end up having to pay a sizeable out-of-pocket bill. Healthcare advocacy services will help patients by re-negotiating what is “reasonable” for the carrier to cover and will work with the care provider to settle on a lower cost for the procedure.

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        Getting Medical Bills Reviewed is Effortless for Patients

        In the smartphone era, saving money through medical bill review is as quick and easy as taking a picture with your phone camera. Fax machines and scanners are unnecessary when you can complete the entire process with your smartphone’s camera and an app.

        With medical bill review in today’s world, a patient submits their bill to an advocate immediately after they find a higher than expected medical bill. A medical bill expert will then review the information and set up a consultation with the patient. During this discussion, the concierge will help the user understand the situation and will collect more information from them if necessary. When it appears that a billing error occurred, the concierge begins the negotiation process with providers on the patient’s behalf. They don’t stop until they have a revised bill or a clear explanation of charges. This process may entail calling the carrier, the provider, and the central billing office. Frequently, multiple calls to each of these parties are required, meaning the patient saves hours by entrusting the negotiation process to the support team.

        Using a medical bills reviewed is the simplest way to ensure employees aren’t overpaying for medical care. Whereas traditional services will have an employee fax, scan or email a medical bill for review, modern advocacy platforms will make the process quick and easy. Once employees realize how painless the process of lowering their medical bill is, there will be little stopping them from using the service. Finally, medical bill review services will reach out to members and recommend that they consult the service prior to future visits so that they can be steered towards the most cost-effective care decisions and avoid excessive fees. The best way for a patient to make educated care decisions, after all, is to be fully aware of the cost of care before using the service.

        Because a medical bill usually brings up more questions than it answers, having an expert advocating on your behalf can be the difference between a bank-breaking fee and a reasonable, predictable expense. Medical billing services at part of a healthcare navigation platform make things simple and easy for members to use.

        When it Pays to get a Second Opinion: Bill Reviews with HealthJoy

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        When it Pays to get a Second Opinion: Bill Reviews with HealthJoy

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        Over the last decade, medical expenses have skyrocketed. To keep up with expenses and maintain affordable premiums, health insurance carriers...

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