How to Save Money by Fixing Health Care Errors

Posted by Adrienne on June 4, 2012

Healthcare Bills… My Part-Time Job. I have a part-time job that I hate. Unfortunately I don’t have the choice to give it up or it would cost me boatloads of money. What is this lucrative but painful job? I correct errors on our health care billings.

You might think this doesn’t apply to you because you don’t have any big illnesses in your family. We don’t either! In my family of 4 we all do the routine check-ups. I think we’re generally pretty healthy but little stuff adds up and insurance (at least ours) is a byzantine system of rules and lingo that seems to be always changing.

source: 401k

As I said – we’re healthy but there’s always something. This year we passed strep throat around. The year before that my kids had ear infections. The year before that my husband stepped off the porch wrong and ended up breaking his foot. Ouch.

I’m guessing I have to make calls on at least 30% of our bills. That is ridiculous! I hope for a day when this stuff isn’t such a mess but until then I need to constantly check things because mistakes are being made. Here are some tips I’ve learned along the way. May they make your health insurance calls easier and more productive.

Tips for Successful Health Insurance Corrections

  1. Know your Plan. You probably got some huge complicated book of mumbo jumbo when you signed-up for your health insurance. Reading the dictionary is probably more fun. Some companies provide a 1-2 page overview but if yours doesn’t here are some key things you should look for:
    • Co-pays. This is the out of pocket expense you pay to visit the doctor. There are probably several different levels depending on who you see (primary, specialist, urgent care, ER). Knowing these can save you big. For instance on my plan the co-pay to see my doctor is $20 but if I go to an urgent care center over the weekend it is $75. Let’s just say my sore throat could definitely wait a day.
    • Deductible. This is the amount you have to pay out of pocket before your insurance kicks in. This could be as low as a few hundred or into the tens of thousands. It could include or not include many different things (co-pays, prescriptions, etc.) If you have met your deductible for the year it makes sense to do any testing or elective procedures also in that year so they’ll have more coverage.

    • Coverage. What % does insurance cover after you reach your deductible? Are any things covered before that? Are there limits on certain types of coverage (for example the number of physical therapy visits)?

    • In-Network. This one is a biggie. Knowing who/what is considered in-network for your plan can save you hundreds if not thousands of dollars. Your insurance may only partially cover out of network services if they cover them at all.

    • Discounts. Some plans offer discounts if you follow their rules. Join a stop smoking group or a healthy baby program. Read these carefully and follow their rules to a T. These programs can be very worthwhile but if you miss one step you’re getting nada. If they want you to send in the same form 3 times – do it. Then call to confirm they got it and record your confirmation number.

  2. Check your paperwork. For my health insurance we get an explanation of benefits after every doctor visit or test. Look these over to make sure it seems like they’re covering what they should according to you plan. Then save these. You’ll need them to cross reference when the actual bills come in. I’ve found many times where the bill did not match up. When I’ve called to dispute the bill it is helpful to have the forms to be able to directly reference what they got paid and what you are supposed to owe.
  3. Know who to call. When there’s a problem with a health care bill there are basically 3 different people to call: Your insurance company, the billing company, and the healthcare provider. If you think the bill is wrong start with the billing company. If you think the insurance is not covering what it should start with the insurance company. You might also need to call your healthcare provider if they have coded something wrong (for instance a wellness visit coded as a sick visit). Things get exponentially complicated if you have to deliver messages between groups. If this is the case make sure you write down exactly what they want you to convey (special lingo, code #s, etc.). It may not make any sense to you but hopefully it will mean something to them.
  4. Be Nice. No one taking your call wants to. Understand that and treat them with kindness – this will go a long way. Even when I’m really frustrated (say 5 calls and still dealing with the same problem ….grrrr) I start out with “I’m really having a tough time with this. I’m hoping you can help me because I’ve tried everything and I’m still having this problem.” You don’t want to make enemies. No one wants to help out their enemy.

How Much Can it Save?

How have I used the above to save money? Here are just 2 examples:

Just last month I was reading the updated benefits coverage from our insurance company (exciting reading I know). I noticed they now covered annual check-ups with no co-pay. I called the insurance company to find out the exact date of this change. Though we had gotten no prior notice the change date was at the start of the year. Then I had to call each of our doctors to get the money back. It took about a half hour but saved us $80.

When my husband broke his foot he got an x-ray and a cast but for some reason his visit with the foot doctor got coded as a surgical consult for over $400. This took several calls with insurance, billing and the doctor’s office to straighten out. Finally it was a helpful nurse who spoke to the doctor personally for us to get this fixed. $400 surgical consult vs. $40 specialist co-pay. Nerve racking and frustrating but not a job I can afford to give up.

I can’t be the only one who deals with this on a regular basis…

What are your best hints for saving on health care?

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Comments to How to Save Money by Fixing Health Care Errors

  1. I have a question or comment. Is it true that you are not responsible for some bills that are over and above what the health care provider “allows” to be charged for that particular visit. How do you know when that happens and how do you combat it. My mother ended up paying for a few thousand dollar procedure that was over and above what was allowed by the health care provider. The hospital said she was responsible for the difference but the insurance company said she was not. Is there some place we can research that and how do we know?

    Jed Ferris

    • Find out why the procedure was performed.
      Take notes, write down procedure codes, times, etc. Best wishes.

      Brent House

    • Hi Jed,

      I get an explanation of benefits from my insurance company that shows what the doctor billed them and what they “allow”. If you are not getting that I would contact the insurance company to find out what they “allow” for the procedure. Armed with that information you can then contact the health care provider. If they’re accepting your insurnace they have to play by the insurance company rules. Sometimes the difference between the initial charge and the “allowed” charge is huge…

      Adrienne

  2. We save a lot of money by using an HSA account. We only pay about $25 per month in HDHP premiums and we are able to direct how we spend the money we put in our HSA account.

    Deacon

    • For some people it is a very good option. I run the numbers our HSA option every year. For us the extra we’d have to pay for doctors visits cancels out what we’d save in premiums…

      Adrienne

  3. When I had my daughter four years ago, the insurance billed it as out of network, charging us over nine thousand dollars. I called the insurance company and got them to fix it so we only had to pay about $2000.

    Linda

    • That is so frustrating! Glad you were able to get it fixed.

      Adrienne

  4. Good to know. I’ve always tended to pay medical bills as they come in without much thought, but they’ve never been significant. I’m having a baby in a couple of months, so I’ll definitely be getting some big bills. I’ll be going over those in detail.

    Rebecca

    • Congratulations! New baby bills are the worse (see Linda above) because not only are they numerous (you’ll get them from the doctor, the hospital, labs, etc.) but having a newborn around makes dealing with stuff like this that much harder. Good luck.

      Adrienne

  5. Good article. And so true; so many things we don’t think about keeping an eye on and this is a big one.

    Linda

  6. The statement of benefits that we get are very hard to decode, almost as if they are trying to hide something from the start. How did you discover the surgical consult vs. the copay issue? From my statement of benefits that would be nearly impossible to detect.

    Martha

    • On that issue I don’t think it I figured it out directly from the statement of benefits. I called the billing company when I got a huge bill and they told me about the coding. I agree with you that the paperwork is not simple. It should be much easier than it is.

      Adrienne

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