There’s a Certificate for Medical Billing?

The quagmire that is the medical billing process is confusing, to say the least.  It is so confusing, in fact, that there are college courses specifically directed toward teaching people how to do it and entire jobs dedicated solely to medical invoicing.  The medical industry is far from the standard consumer model where you choose a product from available options based on perceived quality, price, and other factors.  Indeed, the product does not even have a set price; it may cost more for you than it does for your neighbor and vice versa.  Partly for this reason, Medicaid (Medi-Cal in California ) and Medicare are constantly investigating fraudulent claims and billing “errors.”

Reports of government waste in Medicaid and Medicare spending are rampant, especially after the passage of Obamacare.  However, individual waste may also be a problem.  Reviewing your available coverage, whether you qualify for Medicaid or Medicare or you have private insurance, is an important first step to determining whether you are being billed appropriately.  Is your care covered by insurance?  If so, what is your co-insurance or co-payment amount for the service provided?  These questions are deceptively simple; in an itemized medical bill, you may find charges for everything from surgery to an ace bandage!  You may find on an itemized bill that you are being double charged for certain items or services.

Once you have determined the charges and your coverage, it is important to review what your insurance pays for the medical service you received.  Generally, your insurance has paid before you receive a bill so you may review the amount they paid against the amount billed to determine whether it was the appropriate amount.  If it is incorrect, you may be able to contest the payment with your insurance company.  Similarly, if something you believe should have been covered does not seem to be paid, then you should find out why.  Sometimes, there is a general rule for your insurance payment, such as a maximum per hospital admittance, or a maximum amount of time at a certain level of care, which may be argued.

Finally, you should look to your bill.  Many insurance providers have negotiated rates for services, which the physician or hospital has agreed to accept as full payment, regardless of the amount they initially billed.  In these cases, make sure that your bill reflects the discounted rate, which typically shows up on your insurance statement.  Billing errors are far more common than you might think, partly because of the varied rates charged for the same services.  Investing a few hours in understanding your medical bills can yield you hundreds of dollars or more, depending on your medical history and needs!

Qualifying for and obtaining necessary medical insurance is a good first step in being proactive about your health.  However, once you have obtained treatment, being vigilant about your billing can save you a substantial amount of money, which you can use toward other important goals, like updating your estate plan!

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