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How to Save Money by Fixing Health Care Errors

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 [1].

source: 401k [2]

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 [3]. 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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