Believe me, I’ve been there … a few times actually.

Getting a monster size bill for a procedure that was ‘supposed to be’ covered can be stressful enough to send you back to the emergency room.

But don’t worry you can get through this. There are a couple of things you can do to get this sorted out and back on your way.

But first things first … don’t panic.

Just because you’ve received a bill demanding immediate payment it doesn’t mean that you have to back out your wallet right away. You’ve got to make sure this is actually your bill, for services you consumed and that your insurance has paid their cut. So here’s where you start.

Get a notebook and pen, then pick up the phone and start talking

1. Confirm that you received a bill and not an ‘Explanation of Benefits’.

I know this sounds easy and stupid, but a lot of times when we receive the explanation of benefits from our insurance company, see the large numbers and mistake it for a bill we are expected to pay.

As an insurance refresher – the Explanation of Benefits provides details about a medical insurance claim that has been processed and explains what portion was paid to the health care provider by your insurance and what portion of the payment, if any, is the patient’s responsibility. 

So give a quick call to the health provider’s billing department and confirm if that’s a bill you are expected to pay.

2. Ensure the provider has your accurate insurance information.

If you’ve changed insurance lately it’s possible that your doctor may have submitted your bill to the wrong insurance company – resulting in rejection and you getting the bill.

It takes a few minutes to call your health care provider and confirm they have the most accurate information.

3. Check for any errors.

You’d be surprised how often this happens, but medical bills can be littered with errors costing you money.

Procedures you didn’t have, incorrect coding of tests, or billing providers as out of network instead of in-network to name a few. So call the health care provider and ask for a detailed itemized bill showing all the charges for every service. ‘

Check your bill for any errors you can readily identify. If you don’t see any errors or things just don’t make sense, then it’s time to give your HR rep a call.

4. Talk to your HR rep about your Health Advocate.

If you have insurance through your employer then talk to your HR  department to find out who’s your health advocate. They might also be called a claims advocate, employer insurance rep, or employer insurance broker.

They work with the insurance provider and the health provider to get more details regarding coverage and will hunt down why the claim is rejected and get it resolved.

Make sure to take very good notes of everything you discuss.

You want to jot down:

  • Who you spoke to (including their employee id (or identifying information))
  • The date, and time of the conversation
  • What they told you
  • Any follow-up details you were told to provide them with and when to expect to hear a response.
  • It’s also helpful to ask that they make a note on your account of the conversation.

I know this is probably the last thing you want to be doing, but don’t let overwhelm discourage you. At least talk to them so they know you aren’t ignoring them.

Start the conversation as soon as you receive the bill.

Although most healthcare providers wait a couple of months before taking action, the longer you wait is the increased risk of your health care provider assuming you won’t pay the bill and send you to collections.

Following up and keeping track of the progress is key.

When we had to contact our claims advocate for the birth of my second child, it was well past his first birthday before things finally cleared up and we still had an amount to pay.

And that brings us to this important point.

Sometimes a covered procedure still costs you big money.

For example:

  • You hadn’t met your deductible for the year before your procedure or hadn’t reached your max out of pocket.
  • Your doctor was in-network, but the hospital she used for your surgery wasn’t so you got charged high out of network fees.
  • Your procedure required an anesthesiologist and they weren’t in the network, again, so you got charged higher fees.
  • Your doctor performed ‘routine’ additional tests with your procedure but your insurance won’t cover it
  • You weren’t sick enough so your procedure wasn’t covered (for example, ambulance rides where if you ‘could have’ driven yourself or wait for a ride, then it wasn’t required and not covered).

Here’s what you can do if you have to pay

All these instances could result in you having to pay a hefty bill for a covered procedure. Now if you’ve gone through the steps and find that the charges were legit, then you still don’t have to despair. There are ways you can lower your medical bill expenses without signing over your kidney.

I detail these tips for lowering your medical bill in a related article.

However, prevention is better than medicine when it comes to resolving bills.

Avoid disputes altogether

So the best thing you can do is to avoid the dispute altogether.

Even if you get things all sorted out, you would have still lost time in emails and phone calls, not to mention the hassle of it all. You can avoid medical disputes by getting a pre-approval before having any medical procedures completed. 

You can ask the health provider to do this but it’s also helpful for you to call your insurance company yourself and check for your coverage, that way you have no surprises. Believe me, a quick phone call can save you a mountain of headache and dollars.

And make sure when you talk to them that they quote you an estimate based on being an ‘insured patient’ and using your insurance. Non-insured payments get quoted ‘non-insured’ prices which can be different from the contracted price for an insured patient. That’s all fancy talk to say if you have insurance then they charge you one price (depending on your provider), and if you don’t they charge you another price. 

It sucks I know. It’s a ripoff… I know. But it’s the system we live in until things get better.

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