Solving Common Billing Questions
The most common causes of billing problems are discussed below with general tips and suggestions for handling each problem.
- Incorrect insurance card
- Failure to obtain pre-certification
- Failure to provide supplemental or spouse insurance
- Failure to understand benefits
Incorrect iInsurance card
The number one cause of billing problems is an outdated insurance card or not having your insurance card with you when you receive medical services. Health plans change their procedures and issue new cards regularly, employers often change health plans and employees often change jobs. It is very easy to use a wrong, outdated insurance card.
- Solving the problem: When you receive the first bill, contact the physician’s office and Hospital to provide the correct insurance information for rebilling.
Failure to obtain pre-certification
Another common cause of billing problems is the failure to obtain pre-certification for a procedure or an admission. Most health plans and insurance companies will not pay for services if they do not give approval in advance or within a designated timeframe, usually 24 hours after an emergency situation.
- Solving the problem: Call your insurance plan’s membership or customer service line to explain the situation. If this is not helpful, ask your physician ’s office to call your insurance plan. You could also talk to your company’s human resources benefits manager since they purchased the plan.
Failure to provide supplemental or spouse insurance
Make sure you give the provider of your medical services all relevant insurance information. If you are covered by more than one insurance provider, be certain to provide this information. This is particularly true for patients who have Medicare and a supplemental policy. Sometimes, in addition to primary insurance, a patient is covered by a spouse’s insurance or by supplemental insurance. If this information is not disclosed at the time of the visit, the physician or Hospital cannot bill against those plans, which might increase the your portion of the bill.
- Solving the problem: Contact your hospital and physician’s office with the additional insurance information when you receive your first self-pay bill so the provider can complete the insurance billing.
Failure to understand benefits
Due to the complexity of managed care, patients often do not understand what procedure and services are covered and what their co-pays are.
- Solving the problem: If you are having difficulty understanding the benefits when you are choosing an insurance plan, you should contact your employer’s benefits manager for clarification. If your question is regarding a previous or future medical service, contact your insurance company directly for assistance.