As healthcare costs continue to climb, patients are often left hopeless when trying to figure out how to pay mounting medical bills for health treatments and services.
Even for patients who are insured, medical bills can be difficult to understand, especially when insurance companies deny claims for certain services or only pay a portion of a patient’s health expenses. For uninsured patients, paying for health services can be an intimidating and tiring task.
This is where a patient advocate can step in.
PPAI sat down with Isaacs before the webinar to talk about some billing concerns that both patients and advocates often come across.
PPAI: What kind of billing issues do you typically deal with and what is the most common billing issue that patients come to you with?
Isaacs: I’ve come across duplicate tests and services, or patients notice something on their medical bill that is wrong. More often though, there are arithmetic errors. With one of my clients, this woman needed an MRI of her head. She went to a primary care physician to get and MRI but she had a hairstyle that was loaded with hairpins and the doctor’s office had to redo the MRI. A year later, she gets a bill for two MRIs and her insurance is only going to pay for one. She kept throwing away the bills and finally it goes into collections. She is then subpoenaed into court and the courts are very much on the side of the patients when they see that medical records are incorrectly kept.
PPAI: What should people pay attention to in their insurance policy to avoid billing issues later on down the road?
Isaacs: Before they have a service, I’d recommend that patients get a pre-estimate from their provider. But what a patient advocate can help with is getting a patient to prioritize the care. This relates to billing issues because if a service or procedure is not medically necessary, then it’s a bad call by the doctor. Sometimes it’s going to be declining care that’s not going to be effective. Medically necessary relates to a diagnosis, so the doctors really have to be sure that what they have discussed with the patients actually related to that diagnosis.
PPAI: What are some important things to keep in mind when reading and trying to decipher a medical bill – both from a patient perspective and an advocate standpoint?
Isaacs: The thing that patients should really do is question the doctor’s office. What I mean is, they should call often and call early. If patients and their advocates are nice and friendly, offices are always happy to help. You should also ask for itemization of a bill and clarification. Also, check to see if that doctor’s office offers different fees. A lot of times you can get a negotiated rate if you can’t pay the full amount of a medical bill.
PPAI: How should you go about disputing a charge on a medical bill?
Isaacs: If patients sign forms about payments in advance it’s usually very difficult to dispute any charges. If anything, a patient advocate can bring a level head to what the issue is at hand because in negotiating billing is a difficult and often stressful and volatile situation.
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