- “When you schedule your procedure, say ‘This is my
insurance. How much will this cost me?’” “If the hospital can’t tell you, that’s a warning sign they might not be
a good deal; once you make two or three calls, you can usually find a
good-value facility.”
- To learn what a reasonable price should be, check out the free, online cost-comparison tool from Healthcare Blue Book (healthcarebluebook.com), which lists “fair” rates in your zip code based on the average insurance reimbursement fee.
- Also try FAIR Health (fairhealthconsumer.org) that lists estimates of providers’ charges for services in your area plus how much of that charge insurance should cover if you go out of network.
- Know that medical codes are another name for costs
- Medical billing runs on three sets of universal codes: one
for diagnoses (ICD-9), one for procedures (CPT), and one for durable medical
goods and certain services (HCPCS).
- To learn what a reasonable price should be, check out the free, online cost-comparison tool from Healthcare Blue Book (healthcarebluebook.com), which lists “fair” rates in your zip code based on the average insurance reimbursement fee.
- Also try FAIR Health (fairhealthconsumer.org) that lists estimates of providers’ charges for services in your area plus how much of that charge insurance should cover if you go out of network.
- It’s the job of the coder to translate every single illness, treatment, and pair of
crutches into a number. Those codes are critically important because they help
dictate the rest of the payment stream that follows.
- It’s useful to learn the codes for your care. “The doctor’s
office can often give you the CPT code for a procedure in advance,” “It might change if anything in your treatment changes, but at least
it would give you a frame of reference.”
- Cost-comparison tools, like FAIR Health’s, allow you to
search by CPT code.
- A coding error could be to blame for an outrageously high
bill.
- If your bill includes codes, check if they jibe with the
ones you got from your doctor beforehand.
- If a bill has codes without corresponding descriptions, call
the billing department to make sure they match the procedure you got (or look
them up on FAIR Health’s site)
- You or a family member could keep a notepad by your bed and
record the tests and medications you receive—and any that are canceled—along
with the dates.
- Some charges, like those for time in the operating room, are
determined by the minute. Have a family member note when you go into and come
out of surgery.
-The recovery room,
where per-minute charges are also used, is another area to pay attention to.
- Everyday items could
mean more bucks on a bill than you expect such as $10 for a diaper in a nursery
and $119 for an egg-crate pad given to a patient who required support in bed.
Have a family member get it from a drugstore or bring it from home.
- Request a detailed itemized statement that breaks out each
specific charge. If you don’t understand an item, ask the billing department to
make sure it matches the care you received.
- For a scheduled procedure, ask in advance whether any
specialists you’ll need, such as the anesthesiologist, are in-network (and
request only those who are).
- If you get an outrageous out-of-network bill, use
out-of-network reimbursement data from sources like FAIR Health to negotiate
with your insurance company for better coverage.
- You can also ask your insurance company to cover an
out-of-network physician at your in-network rate
Some patient advocacy resources:
-The US dept of Health & Human Services - free
-Medical billing advocates of America - rates apply
-Patient Advocate Foundation - free
-Advocacy for Patients with Chronic Illness -free
Some patient advocacy resources:
-The US dept of Health & Human Services - free
-Medical billing advocates of America - rates apply
-Patient Advocate Foundation - free
-Advocacy for Patients with Chronic Illness -free
-Excerpts from an article in Reader's Digest. Read the full article here
