All it takes is a visit to the doctor and a few tests or pretty much any visit to the hospital and you’re very likely to see a large number of medical bills. They just seem to keep rolling in, even when you’re relatively healthy. Expert advice is to check your medical bills before paying them–carefully–as they may be wrong.
All kinds of factors can cause errors, including simple human data inputting mistakes or miscoding by health care providers. So much information is collected and reported that it’s inevitable that there will be mistakes.
So, check to make sure that your medical bills are for services you actually received. If you’re not sure, call your doctor to find out. And, make sure you understand your health insurer’s deductibles and copays. They can change from one year to the next.
Beware of surprise medical bills, bills you don’t expect from doctors who are not in your insurer’s network. Too often, people get care from out-of-network doctors who are working in an in-network hospital. If you get a surprise medical bill, here’s how to protect yourself and contest it.
And, if your insurer denies coverage, you should appeal. If you have Medicare, it’s easy, costs you nothing, and you have a high likelihood of winning and getting Medicare to pay. With traditional Medicare, all you need do is return the Medicare summary notice to Medicare, circle the denial and fill out the section at the bottom of the MSN for the Medicare insurance carrier to review the denial. For more information, read this post from Just Care on how to fight back and appeal if your health plan denies coverage.
If you have Medicare, State Health Insurance assistance Programs, SHIPs, provide free counseling to help advise you on your medical bills. You can find the number for your state’s SHIP online or by calling 800-677-1116. You can also contact the Medicare Rights Center, which provides free Medicare counseling services, at 1-800-333-4114. For information on other free and low-cost services, visit the Just Care Get Help page.
Here’s more from Just Care:
- Four tips for keeping your health plan costs down
- How to protect yourself against unexpected medical bills
- Four things to know if your income is low and you have Medicare
- Five programs that lower your costs if you have Medicare
Although you may not win, you can also file an appeal with your insurer. If you lose, just keep appealing! If the appeal is costing the insurance company more than the cost of the service, they might drop the claim on that basis.
I thought Medicare regulations say that providers cannot not bill you if they had not advised you that a service would not be covered under Medicare. Perhaps not being a participating provider is different?
Good point. You should definitely appeal if Medicare denies coverage for a service, whether you’re in traditional Medicare or a commercial health plan. It’s easy, costs nothing, and there’s a good chance you’ll win. Here’s some advice from Just Care on how to appeal: https://justcareusa.org/if-your-health-plan-denies-payment-fight-back-and-appeal/ And, yes, you are correct, your doctor or other health care provider cannot bill you for a Medicare-covered service if Medicare denies payment, unless the provider has notified you in writing in advance and had you sign a waiver agreeing to pay privately for the service.