Hi Brian! Glad you filled us in with some of the info. I respect privacy 100%.
What I can tell you about what I did for our household, after alphabetizing the whole thing..................and more bills were coming and coming and coming..............
FIRST: The patient has insurance. One is the primary and ONLY insurance... OR One is primary, there is a secondary, and even in some instances there is gap insurance. The patient knows, from looking at the policy they are paying on, who is who and what they are paying for. Just because you have Blue Cross/Blue Shield it DOES NOT mean that person B and person C have the same PLAN............ooooohhhhhh...............PLANS! Yeap, plans. So, what does the plan cover? Percentage in network? Percentage OUT OF NETWORK? Just because procedures are done in ONE hospital, for example, does not mean that ALL PROVIDERS were part of the network. This is where it gets wild.....................hang on! If one or more providers were NOT in the network.............then, patient has to wait and see what the policy will cover. EOB = Explanation of Benefits, those papers that come in the mail and are almost unintelligible, and have footnotes, and an explanation at the end. Okay.................. Before you contact anyone for explanations, and saying who paid what, and what you understand SHOULD be paid................wait!!!!!!!!!!! Get an OLD FASHIONED NOTEBOOK, yep, spiral bound, red pen, black pen. If you own a phone with a headset capability, put it on............you will be on hold for... minutes, to hours. Now: Very Important! DATE OF SERVICE
That is the date in which the_____________was done plus the XRAYS were done, plus the____________was done and DR. "Patel" came in to see the patient in the room for 3 minutes.
Doctors in hospitals do NOT work for the hospital. They are HIRED as sub-contractors by the hospital. So, expect to get a bill from:
Hospital Anesthesiology Lab work X Rays Scans MRI's Ultrasounds Venipunctures Pills Toothbrush and comb ETCETERAAAAAA!!!!!
Some doctors come in, listen to the heart, walk away. Do not acknowledge relative/friend sitting there, like a lump on a log. WAIT!!! You have the right and the need to ask: Dr., what is your name please? What is your specialty? Where is your practice located? That way, when you are annotating things of importance in your trusty notebook, you will know! OH, yeah, that was the Dr. with the Birkenstok's and the Hawaiian shirt! Uh hum. Guess what??? HE IS NOT IN THE PATIENT'S NETWORK!!!!! So, primary will not touch it, secondary MIGHT, Medicare COULD.
Nutshell: Keep track of everythingggggg! yeap, on top of being there for the patient, advocate, interpret, accompany, soothe, button pusher and gown straightener, you have to keep track of what and who goes on into the room.
If we are talking PAST TENSE bills........................ok........................Organize them by DATE OF SERVICE. Highlight it in YELLOW.
Let them digest in the SYSTEM for a while...............
DO NOT PAY ANYTHING unless you are 1,000,000% sure you must.
Let them digest a bit more.........................
When reminders begin to come in the mail, perhaps the whole ordeal has been sorted out. It is a morass of medical lingo plus financial strain on the poor patient and family.
Then if you feel adventurous, with your trusty headset on, your favorite comfy chair, and a stack of notices on hand, you can call and see how they can assist you. Calling VERY LATE in the day helps tremendously. Believe me, I know what I am talking about (for once) haahhahahahaha..................ok forum readers, behave! Brian, I wish you the best, and keep coming back and update us. We are, as a whole, a whole bunch of people that are going thru the mill together!
Your friend can also call the specific doctor(s) and ask to speak to someone in the billing department.
Another thought....if none of the suggestions thus far will work for your friend, and he/she can afford it, estate planning attorneys have paralegals, some of whom may have experience in this area and could assist. But you should expect to pay for this assistance.
Another option is to take a course in medical billing interpretation. Much to my surprise, these kinds of courses are taught in some adult ed programs - I've seen them listed. Apparently there's a perceived interest/demand for explanations and other folks are having the same problem as your friend.
One method which can be done either manually or using Excel is to create a spreadsheet listing the dates, doctors, procedures, total amount billed, amount paid by BCBS and amount billed to the patient.
It's easier to analyze if it's all done in writing (or print).
If your friend has Medicare, add that in, and include the amount approved by Medicare as well as the amount it wouldn't pay. Medicare also includes references to specific portions it doesn't pay, providing the justification for the denial.
It can be confusing for the uninitiated to figure out bilsl, why something has been paid and another portion hasn't. And of course there are items for which neither Medicare or BCBS will pay.
Your friend might also have to call BCBS directly to determine if some of the charges aren't ones it will reimburse.
Tell them directly what's your concern about the medical bills. Billing departments do make errors - I've caught a few here and there on my medical bills. Don't let the billing department intimidate you. I've never used a medical billing advocate, but I heard about this place on a financial news show and I think it's an excellent resource for people "new" to the realities of dealing with the healthcare system.
No need to go into the specifics on this forum about your friend's situation.
I'm new to the forum, so I'm just trying to navigate properly. I'm pulling this together for a dear friend. 10 different bills, some of which don't seem to be accurate to me. I'd rather not go over specifics of the current state of my friend. His insurance is Bluecross Blueshield. If I'm in the wrong place asking for help please let me know. Thanks
Brian, I completely agree with the 2 previous posts. Are you overwhelmed? More information is needed so that WE can go to work on the answer to your question. No details, just example: Medicare is primary insurance, so and so is secondary. Billing is for my *mom*, *dad*, *self*, whatever.
I know that when my hubby had open heart 6 yrs. ago, the bills were overwhelming. I created a file folder and alphabetized the whole thing. I made a cardboard sign as big as I could for my desk which stated what doctors did what & when (I was receiving bills from SIXTEEN places at once..........). I felt I needed an accountant to figure out what in the world was going on. .........................................................Help us so that we can help you!.....................
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Glad you filled us in with some of the info. I respect privacy 100%.
What I can tell you about what I did for our household, after alphabetizing the whole thing..................and more bills were coming and coming and coming..............
FIRST: The patient has insurance. One is the primary and ONLY insurance... OR One is primary, there is a secondary, and even in some instances there is gap insurance. The patient knows, from looking at the policy they are paying on, who is who and what they are paying for.
Just because you have Blue Cross/Blue Shield it DOES NOT mean that person B and person C have the same PLAN............ooooohhhhhh...............PLANS!
Yeap, plans.
So, what does the plan cover? Percentage in network? Percentage OUT OF NETWORK?
Just because procedures are done in ONE hospital, for example, does not mean that ALL PROVIDERS were part of the network.
This is
where
it
gets
wild.....................hang on!
If one or more providers were NOT in the network.............then, patient has to wait and see what the policy will cover. EOB = Explanation of Benefits, those papers that come in the mail and are almost unintelligible, and have footnotes, and an explanation at the end.
Okay..................
Before you contact anyone for explanations, and saying who paid what, and what you understand SHOULD be paid................wait!!!!!!!!!!!
Get an OLD FASHIONED NOTEBOOK, yep, spiral bound, red pen, black pen.
If you own a phone with a headset capability, put it on............you will be on hold for... minutes, to hours.
Now: Very Important! DATE OF SERVICE
That is the date in which the_____________was done plus the XRAYS were done, plus the____________was done and DR. "Patel" came in to see the patient in the room for 3 minutes.
Doctors in hospitals do NOT work for the hospital. They are HIRED as sub-contractors by the hospital. So, expect to get a bill from:
Hospital
Anesthesiology
Lab work
X Rays
Scans
MRI's
Ultrasounds
Venipunctures
Pills
Toothbrush and comb
ETCETERAAAAAA!!!!!
Some doctors come in, listen to the heart, walk away. Do not acknowledge relative/friend sitting there, like a lump on a log. WAIT!!! You have the right and the need to ask: Dr., what is your name please? What is your specialty? Where is your practice located?
That way, when you are annotating things of importance in your trusty notebook, you will know! OH, yeah, that was the Dr. with the Birkenstok's and the Hawaiian shirt! Uh hum. Guess what??? HE IS NOT IN THE PATIENT'S NETWORK!!!!!
So, primary will not touch it, secondary MIGHT, Medicare COULD.
..==================================================
Nutshell: Keep track of everythingggggg! yeap, on top of being there for the patient, advocate, interpret, accompany, soothe, button pusher and gown straightener, you have to keep track of what and who goes on into the room.
If we are talking PAST TENSE bills........................ok........................Organize them by DATE OF SERVICE. Highlight it in YELLOW.
Let them digest in the SYSTEM for a while...............
DO NOT PAY ANYTHING unless you are 1,000,000% sure you must.
Let them digest a bit more.........................
When reminders begin to come in the mail, perhaps the whole ordeal has been sorted out. It is a morass of medical lingo plus financial strain on the poor patient and family.
Then if you feel adventurous, with your trusty headset on, your favorite comfy chair, and a stack of notices on hand, you can call and see how they can assist you. Calling VERY LATE in the day helps tremendously. Believe me, I know what I am talking about (for once) haahhahahahaha..................ok forum readers,
behave!
Brian, I wish you the best, and keep coming back and update us.
We are, as a whole, a whole bunch of people that are going thru the mill together!
;^) M88
Another thought....if none of the suggestions thus far will work for your friend, and he/she can afford it, estate planning attorneys have paralegals, some of whom may have experience in this area and could assist. But you should expect to pay for this assistance.
Another option is to take a course in medical billing interpretation. Much to my surprise, these kinds of courses are taught in some adult ed programs - I've seen them listed. Apparently there's a perceived interest/demand for explanations and other folks are having the same problem as your friend.
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It's easier to analyze if it's all done in writing (or print).
If your friend has Medicare, add that in, and include the amount approved by Medicare as well as the amount it wouldn't pay. Medicare also includes references to specific portions it doesn't pay, providing the justification for the denial.
It can be confusing for the uninitiated to figure out bilsl, why something has been paid and another portion hasn't. And of course there are items for which neither Medicare or BCBS will pay.
Your friend might also have to call BCBS directly to determine if some of the charges aren't ones it will reimburse.
Tell them directly what's your concern about the medical bills. Billing departments do make errors - I've caught a few here and there on my medical bills. Don't let the billing department intimidate you. I've never used a medical billing advocate, but I heard about this place on a financial news show and I think it's an excellent resource for people "new" to the realities of dealing with the healthcare system.
No need to go into the specifics on this forum about your friend's situation.
I'm new to the forum, so I'm just trying to navigate properly. I'm pulling this together for a dear friend. 10 different bills, some of which don't seem to be accurate to me. I'd rather not go over specifics of the current state of my friend. His insurance is Bluecross Blueshield. If I'm in the wrong place asking for help please let me know. Thanks
I completely agree with the 2 previous posts. Are you overwhelmed? More information is needed so that WE can go to work on the answer to your question.
No details, just example: Medicare is primary insurance, so and so is secondary. Billing is for my *mom*, *dad*, *self*, whatever.
I know that when my hubby had open heart 6 yrs. ago, the bills were overwhelming.
I created a file folder and alphabetized the whole thing.
I made a cardboard sign as big as I could for my desk which stated what doctors did what & when (I was receiving bills from SIXTEEN places at once..........).
I felt I needed an accountant to
figure
out
what
in
the
world
was
going
on.
.........................................................Help us so that we can help you!.....................
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