A follow up to billing issues …

I wrote a blog post recently about feeling in the middle between my insurance company and my cancer center this week and you can access that here if you are curious about that. In the midst of that experience, I had multiple conversations with people in my life about medical billing issues AND received bills for my father in law naming my husband, who holds power of attorney for decision making, as financially responsible. As I talked with various people, I realized that some things I thought were relatively well known probably aren’t.

So here are some pieces of knowledge that may or may not be helpful when you receive a medical bill as a patient or someone related to a patient.

First in Line. The first bill that is received by the insurance company is typically the first bill that is paid. Depending what your medical provider’s system for billing is, they might not send out a bill to be paid until months after treatment. When you have a bunch of medical providers, this can be super complicated. It’s always good to call your insurance company when you get a bill to see if there are others in process or which bills have been processed. So much crosses in the mail so paying quickly can be actually be a detriment.

Reviewed/re-negotiated/adjusted. Your health insurance company may revise or review or even re-do explanations of benefits (EOBs) quickly or not so quickly — this also depends on the time of the year and the funds in reserve. Depending on what you have paid and when, this process may result in having a balance or a refund on one account, but that might affect new bills or new EOBs already in line. Knowing what you owe, your out of pocket maximum, is key here. Once you have paid that total amount, you don’t owe anything further, under every insurance policy I’ve ever seen. Keep careful track so as not to over pay because it is super super hard to get funds back once you’ve paid! Don’t fall for the argument by billing departments just to pay and let them reconcile later — that’s a big fat lie and only benefits them, plus many of them get bonuses based on how much money they collect.

Balance Billing. This is a thing that really infuriates me. If you have insurance (including Medicare and Medicaid), you have a contract that governs how much you pay to any medical provider that has a contract with your insurance company or not. Bottom line: THE CONTRACT IS IN CHARGE, then the laws that interpret the contract are next. If a provider is in network, your responsibility is likely only your co-pay and perhaps a co-insurance percentage up to your out of pocket maximum. If the provider is out of network, then a different equation applies, but really just has more elements. If any provider sends you a bill for the balance after you and your insurance company have paid, you usually don’t owe that. Typically, balance billing is illegal as well as immoral. Don’t just pay bills, ask questions!!

Surprise Billing. This happens a lot when you are in the hospital or you have a procedure in a facility. Maybe your hospital is in your plan, but then there is a company processing your probably daily bloodwork that is not on your plan. This exact scenario happened to me. I received a really big bill after getting out of the hospital from a company not on my plan — when I called and explained that I didn’t owe anything to them, the person acknowledged that that was true but that they send out bills to see if they can get paid anyway. A provider who is not on your plan but contracts with someone on your plan can try to get paid and often asks for an assignment of benefits to get paid — this is perfectly fine. Just sending out a bill to see if you will erroneously pay them is a huge no-no and that company suffered for doing that to me. But at the end of the day, you likely shouldn’t be responsible for the balances if the choice to utilize a provider out of network isn’t made by you.

Lots of Bills. My hospital system has a different billing system for the doctors (even down to different types of doctors), the cancer center, the outpatient centers, and the hospital itself. While all of the bills say they come from the same place (same letterhead and formatting and everything), there are different systems depending on where treatment is rendered and by whom. I’ve learned not to pay any bills quickly, but to wait and review everything. In order to avoid having a bill sent to collections, make sure you call the billing department and let them know what’s going on, that you aren’t generally opposed to payment, but that you need to time to review.

Bills months later. My mom got a bill years after she had already paid it. Someone was cleaning out the old records and the payment hadn’t posted or attached to the invoice. My mom had the information to be able to explain that the bill had been paid, but this can also happen when the bill might be owed. For those of us who are in active treatment, it’s usually not an issue since we’ve met the out of pocket maximum already. But if that’s not you, understand that there are very few limitations or requirements on the timing of billing. Ask questions and do research if a random bill shows up in the short or long term since “receivables” or the money owed to a company can be bought and sold and borrowed against in a variety of ways.

Collection Agencies. Anyone who has dealt with a collection agency for any reason knows that it’s not fun for anyone. I’ve had clients in the past and friends who were browbeaten into making payments they really knew they didn’t owe. The tactics used are frankly pretty awful. But here’s the thing … under the Fair Debt Collection Act, if you tell the collection agency that you don’t owe the money, they have to STOP CONTACTING YOU. In fact, there are fines if they do. So calmly tell them, I dispute this bill, I don’t owe it, and then hang up. Don’t spend your energy dealing with collection agencies.

Responsible Party. At a basic level, if you aren’t the patient and if you haven’t agreed to be responsible, you aren’t responsible for a bill. Here’s an example — my father in law resides in a nursing home (and has for years); he has Medicare and Medicaid and my husband holds his power of attorney for medical decisions. We often get bills that list my husband as a “fiduciary” and try to argue that that means he is responsible for paying the bills. A fiduciary is only responsible for acting in the best interests of someone else within the bounds/confines of a document like a power of attorney; typically, this position does not come with any sort of liability. So, every time, I call and explain. Usually it’s an issue on their end, but sometimes they try to convince me that we have to pay to no avail. It is important to note that in some states, in some situations, a spouse can become responsible for medical costs, so definitely research this to know if that applies to you.

I can’t finish this post without mentioning the CARES Act, which changed the landscape in a lot of ways for patients and providers. One of the biggest things that the Act requires is that any medical results (like bloodwork or the report of a scan) have to be released to the ordering medical provider and the patient at the exact same time. This has been huge for those patients whose doctors would wait to provide results until an appointment and then don’t have availability to meet for a long time. The Act also covers Balance and Surprise Billing and helps to make those both illegal across all states since there were inconsistencies between states.

Bottom line, just because you get a bill, that doesn’t mean you owe it. It’s always a good idea to pick up the phone, ask questions, and be sure that you really do need to fork out your hard earned money; additionally, payments plans are almost always an option, so don’t feel pressured to pay the entire bill and don’t make your inability to cover an entire bill to prevent you from asking for accommodations.

When dealing with any entity who is asking/pushing for payment is good to ensure that you know the following:

• Know your responsibilities under your health insurance plan — the contract wins every time.
• Don’t accept any verbal explanation, ask for the document or agreement or law that provides for responsibility.
• Don’t always pay right away — be sure you know if other bills are coming and what has been submitted to your insurance company and then wait 30 days or so to ensure that you have every bit of information you need.
• If you feel as though you are in the middle between your provider and insurance company, consider scheduling a conference call with both so that you can hear them talk to each other directly and work out details.

No person deserves to be treated badly in the financial/collection process. Know your responsibilities, know what should be happening as much as possible, and stand firm. At the end of the day, if you actually owe something, there is nothing wrong with asking for a payment plan and for the company to waive any interest that might accrue. And if you don’t agree, tell them.