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Health Reform 101

with Lisa Zamosky

WebMD helps readers understand their health insurance and the new health care reform law. The Affordable Care Act is bringing sweeping changes to American health care. Lisa Zamosky is here to help you navigate the health care maze and understand how these changes affect you.

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Thursday, January 12, 2012

Health Care Bills: Four Mistakes That are Costing You Money

By Lisa Zamosky

You may not have control over high medical costs, but when it comes to medical bills you can make a huge difference in how much you pay for your care. The key is to know when and where to take action.

Here are four mistakes that can take a big financial toll when it comes to medical bills.

1. You don’t review your bills. Medical bills are notoriously riddled with errors. If you pay your bills without reviewing them with a fine-toothed comb, you’re very likely to pay more for your medical care than you should.

The solution: Be on the lookout for additional hospital days, duplicate or excessive charges, charges for doctor visits or tests you never got, or any number of items that don’t jibe with the care you believe you received.

Address any errors right away with the billing department or office manager in your doctor’s office or the hospital where you received care.

2. You don’t confirm that your insurer paid. Another form of medical billing error often occurs in the form of doctors or hospitals failing to bill your insurance company or doing so improperly. If you have more than one type of insurance, it’s very common for confusion to occur about which company should pay first and which should pick up the remainder of the bill.

Before you pay medical charges, make sure that your health care provider has properly billed your insurer and that your insurer has, in turn, paid what it owes.

3. You accept defeat without a fight. It’s a huge mistake to assume that being denied coverage by your insurance company means the decision about whether or not your care will be paid for is final.

As a result of the health reform law, you have the right to appeal coverage denials by your insurance company. If your insurance company does not rule in your favor your plan is required to explain why and provide you with information about how to obtain an independent review of your case (this doesn’t apply to grandfathered health plans).

Not only is it your right to appeal, there’s evidence that doing so pays off. A report conducted last year by the Government Accountability Office (GAO) found that as many as 59% of health insurance appeals were decided in favor of the patient. And 40% of external appeals — those reviewed by an independent third party — were reversed in the patient’s favor as well.

Bottom line: If you don’t fight back you’re probably leaving money on the table.

4. You don’t negotiate. Here’s a fact that makes many patients uncomfortable: You need to haggle with your doctor over the cost of your care. Prices for medical care are not set in stone and you can save yourself a lot of money by asking for a break. This is particularly important if you’re without insurance or if you have a high-deductible health plan that requires you to pay thousands of dollars before insurance kicks in to help pay the bills.

You can arm yourself for negotiation by researching a fair price for the medical service you need. Many health insurers offer members a pricing tool that can be found on the company’s website. And online tools such as Healthcare Blue Book are available to those without insurance or with a health plan that doesn’t offer the service.

What financial mistakes have you made when it comes to medical bills? Share your experience in the comments section.

Posted by: Lisa Zamosky at 12:07 pm

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