Don’t let medical billers cheat you

When it comes to medical billing, let the patient beware. The next time you receive a bill, check it carefully. The amount it says you owe may be more than it should be.

Here are two examples involving people I know.

A neighbor recently visited an orthopedist for a spinal injection. When I saw her several days later, she said the procedure had gone well medically, but the financial side seemed to be off. Before the doctor would see her, she was asked to pay $400.

She had good insurance coverage. Medicare was her primary insurance, and a private policy provided secondary insurance to cover any gaps. I wondered whether the doctor's office had properly billed both plans, and I advised her to call to check.

As you might expect, she spent a long time on hold and was shuttled between several employees. She finally reached an unpleasant billing clerk, who told her that the secondary insurance company had not, in fact, been billed. Had it been, the $400 would have been covered.

When my neighbor asked that the practice send her a refund, the billing clerk gruffly promised to relay the message to a higher level employee. But she was also told that there would be no refund until the practice had received the secondary insurer's payment. How would she know when that had occurred? She would just have to keep calling.

Last week, my husband, who is also a Medicare beneficiary, underwent a diagnostic procedure at a hospital. The bill was for only $50. Ordinarily, we would have paid without thinking, but I was curious as to the reason for the charge. I contacted the hospital's billing department to see whether the claim had been submitted to our secondary insurance company, and, not surprisingly, it had not been. The billing clerk with whom I spoke promised to submit it immediately and said my husband could disregard the bill.

These errors often arise from simple sloppiness. But in some cases, there is a more sinister explanation. Many physician practices reward the office staff based on the amount they collect from patients to cover charges that are not reimbursed by insurance, such as co-payments and deductibles. An easy way to increase those amounts is to neglect to submit bills to insurers in the first place.

The next time you receive a medical bill, read it carefully. If there is anything you don't understand, call the provider. Even if it means spending a while on hold, your investment of time could be worth it.

-----

Have a health care question or frustration? Share your story »