I’m sure most of us have experienced this, either healthy or sick. A collection notice shows up at our door for an unpaid medical bill. The first time it happened to me, it turned out a hospital in NY had sent the bills to a different address of record. One I had lived at 3 (COUNT IT) residences ago… I had even taken the liberty to update it right away with the hospital after each move to guard against this. Yet, it happened…
This was when collections agents were decent when you explained you had never received a bill. I called & told them I never received a bill & needed to call my insurance to see if it had ever sent to them. Turns out they did all that for me, and I had to pay a portion, but not the full bill I was sent since I had remaining deductible & that’s all I needed to pay. I didn’t have a problem paying what I knew I owed once it was explained what I was responsible for & why.
Yet, I know several others who this happened to who found this out only after their credit report had come back with that awful black mark on it & prevented them from getting credit for something like a car, a home, or other important need. They had no defaults & perfect scores prior to.
A few of us are old enough to remember at time when they couldn’t use medical debt against someone in their credit report. Then things changed & suddenly many people were in trouble.
Yet, we always longed for the days before. Now, according to this article, there seems there is hope of these days returning; or at least taking steps to go back to those “good old days”.
It’s not just errors in bills that are of concern. It’s situations like mine that I outlined in the first paragraph. Now it seems an act of Herculean strength to get something fixed because you have to go through about 3 different parties to resolve it for one bill. It can be something as simple as an incorrect address on file for the consumer, an incorrect insurance address, or an actual billing error where something doesn’t match up. Or even attempting to fight a balance bill because the entity doesn’t agree with their reimbursement from the insurance company. All of this can lead to these notices & cause a fair amount of grief for everyone.
This Kaiser Family Foundation article outlines the problem well. Most of the increased debt lies in shrinking benefits & increasing deductibles that require a person to meet more of the cost out front before their carrier even begins to pay. This is also complicated by confusing billing practices.
Unless someone is well-versed in medical coding & billing, it can be very hard to pick up on billing errors unless one is savvy enough to match their Explanation of Benefits to each bill at each occurrence & that bill you receive actually happens to be itemized (many are not). This makes sense & can be easy enough to reconcile if the bill comes to you in the same year but what if it’s years after the fact? Or a statement with just a date & notice of collection with no information. On that date, especially with hospitalizations, it can be hard to see if that amount is the bill before or after insurance responsibility or who it’s actually for.
I worked for a few years on the front lines trying to help people fix errors such as these & it was difficult to do even when the insurance carrier is trying to assist & an agent can match something up eventually. If one was luckily then after a week & about 3 calls, then the person would finally get an itemization for that mystery bill to help figure out what exactly was being billed & what their true responsibility is.
A few times it was a balance billing for an amount that didn’t match the Explanation of Benefits; in essence a dispute with the reimbursement taken out not on the insurer but on the patient themselves. Not an illegal practice, but a crappy one.
Who knows how many bills I paid unknowingly with those discrepancies simply because I wasn’t sure of the ins and outs of insurance & couldn’t match up a bill because it came months or years after the fact? People tend to dismiss it sometimes especially if its a smaller amount because they figure they owe it & don’t want to take a hit on their credit report.
I’ve really seen some nastiness come out in billing people when any type of billing confusion occurs & the consumer questions why their responsibility is what is on the bill when it doesn’t match up to what their insurance paid. It’s enough to sincerely wish balance billing was illegal because such disputes that cause them can’t be fixed by the consumer because it’s not their responsibility to fix. They need to be duked out between the insurance & the provider since that is who the contract is between, period. Yet unfairly the onus is placed on the consumer to detect & challenge such instances & disputes (which seems backwards). Often this is done as a means to pit the consumer against their insurer to try & get them to pay more than the contracted amount. It’s shadiness to the Nth degree.
Pat Palmer has a great explanation of how medical debt can affect someone’s credit score & the type of hit it can take while these reforms are being enacted & adopted. Pat is founder of Medical Billing Advocates of America, a company that helps people audit & dispute medical bills.
This article from The Atlantic outlines the average consumer’s confusion surrounding billing practices very well & the problems even savvy consumers face in trying to rectify those errors.
Even if you know your benefits, sometimes they can vary by how the doctor bills, whether they classify as an in our outpatient service, on a campus of a hospital versus private practice, it can get very confusing very quickly. Add to it that certain diagnoses like maternity & mental health often have different & separate benefits from just a doctor visit for a stomach ache.
Even if you know your plan, it is illegal for an insurer to tell a provider how to bill. So how do you know that they are actually doing it right, especially when there could be more than one way to bill it? People are human, after all. These are also problems that shouldn’t be consumer responsibility, but often have to be now in order for problems to be solved. At least if you know what they are billing & it’s clearly wrong, you can contest it with either your carrier or the provider or both. No guarantee but it’s at least buying time & breathing room & sometimes is just as simple as that to fix.
(I contributed to this article back in March that might help give some pointers on how to start a conversation with an insurer in regards to a large bill to even see if it has been sent to them. Which is always a good place to start with trying to unravel the mystery.)
Why am I blogging about this? Because transplants are hospitalizations. Costly & expensive ones at that. Plus there are other services & claims that go along with this both before & after the actual operation. The potential for errors with hospitalizations is always high because those expenses are not just one giant claim but several separate claims.
I at least have had enough prior hospitalizations & good & bad experiences to know how to examine my insurance claims surrounding major medical expenses. But a lot of that I had to figure out on my own through trial & error the hard way before I actually was on the inside helping others. I carry my full insurance policy on my phone so I can immediately tell if I have a question how something “should be” covered. Having been in customer service & helping people with many different plans & scenarios has also helped increase my understanding of how this whole business works so I may have more tools at my disposal to solve an issue if it arises.
But I point it out, because some people aren’t even aware that such messes can occur, until they are knee deep & frustrated. If my “boring blogging” about this saves someone some grief or points them to a resource that can help, then it is time & energy well-spent on my part to compose a post that might give a few simple pointers on how to start to unravel a mess when it occurs.