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.

Ways to Pay Off Medical Bills If You Don’t Have Healthcare Coverage

The impact of health insurance premiums and treatment costs continues to be a major concern for consumers. In addition, a recent industry survey indicated that 77% of consumers struggled using their health insurance in the past year. While we anticipate what’s to come on the healthcare landscape, here are some ways to reduce and or at least manage your medical costs, with or without insurance.

  1. Speak Up: Let your healthcare provider know how medical costs can impact your personal situation. Most providers provide quality care. Sometimes, this could mean extra costs to you. However, if you plainly explain to your doctor your concerns and are seeking ways to keep them in line while effectively treating your condition, s/he can prepare a treatment plan with this in mind.
  2. Unnecessary Procedures: Understanding your sensitivity to costs, your physician might eliminate less necessary tests or delay tests, if possible, without compromising your situation.
  3. Generic Medications: Costing up to 80% less and just as effective as brand names is a good way to reduce the prices of your prescriptions. There are a number of good resources for this.
  4. Online Research: Do your homework before the procedure to compare costs in your area. Use this information as a guideline. Remember, there are many factors in determining why a procedure costs what it does. In addition, contact your own insurance plan or use their cost estimator tool.
  5. Right Facilities: Urgent care clinics can cost a fraction of hospitals and emergency rooms when it comes to doing procedures, tests or blood tests. These are good for non-emergency care.
  6. Cash Payments: If you can pay cash, ask about cash discounts. It’s less work for the administrative offices.
  7. Payment Plan: Avoid putting a large medical bill on a credit card. Instead, ask if you can pay using a pay plan. Most providers offer this and in some hardship cases, they might even reduce what you owe. Find out what your doctor’s payment options are.
  8. Medical Advocates: For complicated cases, a medical or patient advocate offers services including helping to research treatment options, tracking paperwork and negotiating lower rates. You may have to pay a fee but it can help unravel complex paperwork or lower outstanding medical costs.
  9. Billing Mistakes: Check your explanation of benefit (EOB) statements to make sure they are correct. Compare them to your actual bill. Industry studies suggest many bills contain errors because of incorrect coding and other reasons. Do not hesitate to call the billing department or your insurance plan’s support hotline to get to the bottom of the bill if you suspect it is incorrect or simply want clarification.
  10. Understand Your Medical Insurance: Make sure your insurer is still in your market and that your provider and facility remains in-network. Many consumers are shocked when they receive a bill they thought would be covered by their insurance only to find out the provider or the facility was out of network with their plan.

Struggling To Pay Medical Bills?

People all over the U.S. struggle to pay medical bills. The unpaid hospital bills will pile up quickly from an unexpected illness. Due to the lack of medical insurance, you may have received a minimum level of treatment and were discharged with a recommendation of going to see another doctor. How do they expect you to see another doctor when you can’t afford to pay their medical bills?

This is the sad reality of the medical industry in the United States. While the current administration promises a resolution, what do you do in the mean time? There are options, however none are absolute. Americans neglect their own health issues until their body won’t let them anymore and sometimes it is too late by then. Waiting makes the issues worse yet many cannot afford the preventative measures and checkups necessary. Your health should be a priority, but the expense of medical bills sometimes makes that impossible.

Medical assistance is available through state and federal programs for some people. Those that are offered medical insurance through their employer sometimes can’t afford it or they have it and it is not as effective as it should be. The rates of insurance are high, the deductibles are high, the co pays are high and the percentage the insurance covers is low. For those who do have insurance these numbers still equal needing help to pay medical expenses.

Medical advocates can help with unpaid hospital bills; however their assistance is limited too. They can find errors in billing and negotiate the numbers, but in the end you still have to find a way to pay medical bills. When there is nothing left to rob from Peter to pay Paul, it is time to consider a different approach to resolve your medical expenses.

Many have not considered bankruptcy to alleviate the stress and financial burden of medical expenses, however many are forced into bankruptcy due to unpaid hospital bills. When you do not have the means to pay medical bills, consult with a bankruptcy professional to help you make the best financial decision.