5 Signs You May Need a Medical Billing Advocate

1. Do you have denied claims that you would like the insurance company to reconsider; yet you are unsure how to appeal the claims?
2. Are you or a family member chronically ill and overwhelmed with sorting through a multitude of bills and insurance paperwork?
3. Do you have elderly parents that need help with their Medicare Supplement and Part D coverage decisions, and you don’t know how to advise them?
4. Have you recently incurred large medical expenses and you are uninsured and don’t know where to turn or what to do?
5. Do you suspect that your medical bills contain overcharges and inaccuracies but you don’t know what to do?

If you answered yes to even one of these questions, consulting with a medical billing advocate is highly recommended. Medical Billing Advocacy of the Rockies provides a free initial consultation to review the facts of your individual situation and will determine whether you have a case, and/or determine what assistance or recommendations they can provide.

“After spending 10 years in the health insurance field working for a major health insurance company, I saw a critical need for this service. Learning and dissecting the healthcare jargon and codes is not something the general population can do, nor has the time to do”, says Holly Knapp, President of Medical Billing Advocacy of the Rockies, LLC. Medical Billing Advocacy of the Rockies located in Loveland, Colorado.

According to Ms. Knapp, some of the common questions from her clients are:

“How can I tell if my medical bills are correct

“How do I know if my insurance company has paid everything they should?”

“How do I know that I am paying what I truly owe? “

The job of a medical billing advocate is to sort out the facts, review itemized doctor and hospital bills, insurance benefit statements, and medical records. “This comprehensive review helps you get fair treatment in a complex and confusing health care system and assures you of a true and accurate bill”, according to Ms. Knapp. Ms. Knapp advocates on behalf of her clients to get them the benefits they deserve, as she resolve billing errors, eliminate overcharges, and negotiate bill reductions.

Medical billing advocates are experienced in helping chronically ill individuals and/or families caring for a chronically ill child, or spouse. According to Ms. Knapp, “When families are dealing with significant health issues, the burden of fighting with insurance companies and health care providers to make sure bills are correct, and properly processed by the insurance company is one more stress they don’t need to deal with at a very difficult time in their lives. A billing advocate can step in to manage the process, and allow you to focus on caring for your loved ones.”

In addition, for seniors who are confused by the complexity of Medicare supplement policies and Medicare Part D drug plans, medical billing advocates who specializes in this area can provide advice and enrollment assistance in a plan that will provide the greatest benefit at the lowest cost.

A recent article published by CBS News, Slash Your Medical Bill; 7 Ways to Haggle offers tips for consumers in how to find medical pricing data for planned medical procedures and then use this information to effectively negotiate with care providers before receiving services. They also offer tips on the best methods to reduce bills for medical services you have already received. An empowered consumer, armed with accurate medical price data, can negotiate on their own behalf to get substantial medical cost savings from both physicians and hospitals.

Holly Knapp is a member of a national organization of medical billing advocates – Medical Billing Advocates of America (MBAA). Advocates come from a variety of backgrounds: health insurance, nurses, lawyers, certified medical coders, and health care administrators. Members support each other in their common goal of a fair and true medical bill, by sharing knowledge and skills as they work together on difficult cases.

Medical Bills and Arbitrary Costs: Add These Strategies to Your Toolkit

Media, consumer advocates and others talk a lot about how many of us are facing absurdly high costs for medical treatments. We know that these charges range significantly from location to location and that many times you may be hit with the majority of the balance. Not everyone, though, is talking about actual, practical ways to protect yourself from excessive costs when you obtain care at a local doctor’s office, hospital or other facility.

Asking the Right Questions

Almost all of the practical strategies for “consumer cost control” in medical offices focus on getting answers from medical providers. Asking relevant questions before, during and after a visit can help you avoid some of the most ridiculous charges that show up on medical bills.

One tip is to ask for an itemized list of charges. Itemization of a medical bill will show you whether any costs for a particular procedure have been padded or exaggerated, for example, in bills for supplies and related expenses. Some doctors have begun to bill different aspects of consultation separately and this is another area where an itemized bill can come in handy.

Look At the Medical Codes

Medical consultants are now advising to look at the CPT codes that show up on your medical bills. CPT codes represent specific procedures and treatments, and you can use these to help find a fair price online. It is becoming increasingly common for individuals to look for these kinds of “blue book values” for medical procedures when negotiating with a provider. Experts also recommend checking out the government’s reimbursement rates for Medicare and Medicaid to see if your doctor is charging you too much for a specific procedure.

Look for Alternatives

Another way to lower overall medical costs is to decline some of the more expensive and less necessary treatments that your doctor may suggest. Lots of medical advocates tell patients to always apply the “BRAIN” ( benefits, risks, alternatives, intuition, nothing) principle to their questions in the doctor’s office. This involves looking at the pros and cons of procedures, as well as what lower-priced alternatives may be available, as well as checking your intuition or “gut feeling” about a suggested treatment. Then, evaluate the consequence of delaying treatment for a health condition.

One reason that consumer advocates suggest this kind of questioning is that a doctor’s suggested treatments are not always the only course of action for any given health condition, and sometimes, a practical approach can reveal perfectly good alternatives that can come with a much lower price tag.

Look for Discounts and Other Payment Options

Another great tip is to look for payment plans and other options from your local medical providers. Many providers have begun to offer these options to patients. Some patients who are facing high-dollar bills can even qualify for charity, especially if their insurer declined huge portions of their bill. Make sure that you keep all of these strategies handy for dealing with medical bills that threaten to ruin your financial health.

Medical Bill Help: Compare Healthcare Costs Before Proceeding With Treatment

The costs of medical and health care services have been rising steadily for many years, and American consumers are feeling the pinch in a big way. Many American individuals and families are now facing extremely high medical debts, some of them for fairly routine or minor health care procedures or treatments. With the private insurance system looking to offset costs, and very little in the way of a safety net for consumers, medical bankruptcy threatens many thousands of families each year.

Now, medical advocates are telling American patients to go a step further than many of them are accustomed to: new guidelines from experts in the industry suggest that consumers should be asking medical providers about how much a certain procedure, treatment or even a consultation may cost before they ever step in the door of the medical office.

Barriers to Asking Questions About Healthcare Services

In prior times, most patients were not used to asking their doctors what something would cost – there was a kind of intuitive understanding that since medical care is something that nobody wants to skimp on, it’s not a situation where prices can be negotiated. Over time, that led up to a system where insurance plans, largely those provided by group employers, covered major costs, leaving a patient with a straightforward co-pay or deductible that would represent their total financial responsibility.

These days, even a group plan doesn’t protect the average consumer from receiving extremely expensive medical bills after getting nearly any kind of health care service. Larger co-pays, larger deductibles and co-insurance mean looming costs for many Americans as medical costs continue to skyrocket and other issues like deceptive out of network charging leave many patients with much more debt than they thought they were going to incur when they arrived at a hospital or other facility.

Can Americans Shop for Health Care?

What new reports are showing is that the best way to shop around for health care is to ask your insurance company. Most of the efforts at cataloging the various rates that different providers charge for services are done by big insurers like CIGNA, Anthem Blue Cross, and other multi-state insurance companies. Patients can also ask their insurance company which providers have a contractual plan that forces them to charge a certain set price for a given medical service.

Over time, this trend will probably continue, to the point where American patients routinely ask their insurance company to help them shop. For most enrolled members, the insurance company has a vested interest in that person getting the cheapest medical care possible. While these kinds of partnerships between private insurers and individual patients can help both parties to rack up less medical debt for the same kinds of treatments and procedures, there’s also a great need for more patient education, where consumer advocates are standing in for states and the federal government when it comes to providing fixes for a problem that is challenging the majority of American families today.