There is nothing more frustrating than dealing with medical or insurance billing errors, which can take up valuable time and cost you money.
The issue is becoming more and more of a problem as businesses shop around for the most competitive plan and employees deal with new plans and changing rules.
What health care consumers don’t realize is that with most plans, almost every procedure or test your doctor orders needs to be pre-certified, or else a notification must be sent to the insurer. And what falls through the cracks or isn’t documented properly can end up costing your employees.
“Ninety-five percent of the public doesn’t know that in the end, they may be responsible for payment,” says Carol Geraci, R.N., and manager of central scheduling at Mercy Medical Center. “They think, ‘I bought insurance, and it covers this, and I should be fine.'”
The devil is in the details, and the details are in the contract with the provider. Unfortunately, many of us really don’t relish spend hours poring over the finer details of our health care plan.
One way to deal with the issue is to never get sick, but for those who can’t seem to help themselves, there are some things to keep in mind.
First, know as much as you can about your plan, and if you have questions, call.
“It behooves you to talk to your insurance company, to call for patient eligibility and see what your benefits really are,” Geraci says.
And have the proper information with you at all times.
“Throw your old card away … always have the right card with you,” says Geraci, because every graphic and number represents the specifics of your plan.
Always get the name of the person you’re dealing with when you call.
“Find one person who you can talk with and can get things done,” she says.
Every procedure has a code, but those are not always black and white, and the doctor’s office can make mistakes.
Geraci suggests, “If you have a code that is not accepted … ask the doctor’s office to check the code or try another one.”
And although the paperwork sent by the hospitals and insurance companies can be indecipherable, don’t give in to the urge to throw it all away. And don’t get discouraged.
“The simple rules of the game are, if you play by the rules, you can win,” says Geraci.
