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  • How to choose Health Insurance Options: Traditional vs. Alternative Coverage

    If you're in the process of enrolling in a new health insurance plan or are about to tackle this important decision, you've likely encountered the overwhelming array of options available. From well-known traditional insurance plans like Medicare and Blue Cross Blue Shield to alternative solutions such as Medi-Share or Christian medical insurance plans, the choices can be daunting. In this comprehensive guide, we'll provide valuable insights into the differences between popular traditional coverage types and alternative healthcare options to help you make an informed decision. Exploring the Landscape of Health Insurance Plans Health insurance plans come in various types, each with unique characteristics that significantly influence coverage rules and costs. The most common types include: Exclusive Provider Organization (EPO) Health Maintenance Organization (HMO) Point of Service (POS) Preferred Provider Organization (PPO) Medicare Traditional and Medicare Advantage Medicaid To gain a deeper understanding of each type, you can turn to resources like Fair Health Consumer for comprehensive information and guidance. Traditional vs. Alternative Healthcare Options While traditional insurance plans like Blue Cross Blue Shield are widely recognized and accepted, alternative healthcare options known as "healthcare sharing plans" are gaining popularity due to their affordability. However, it's crucial to understand the drawbacks associated with these alternatives, which may make them less suitable for you compared to traditional insurance plans. Healthcare sharing plans differ from traditional insurance in fundamental ways. They are not bound by the regulations of the Affordable Care Act (ACA), and over twenty-five states exempt these plans from insurance rules and regulations. This lack of regulation means policyholders may be vulnerable in the event of disputes or denied claims, as the same consumer protections and guarantees do not apply. Members of healthcare sharing plans contribute a set monthly amount to their own account and then submit requests for help to cover medical expenses. If approved, other members use their funds to pay the healthcare provider directly. However, these plans are faith-based, meaning that expenses not aligned with the plan's belief system are not covered. Additionally, coverage for certain medical services, procedures, or pre-existing conditions may be limited or excluded, potentially leading to significant gaps in healthcare coverage. Although these sharing plans originated in the 1990s and operate as not-for-profit organizations, their long-term viability can present risks due to their reliance on the concept of sharing healthcare costs among members. Economic challenges or changes in healthcare regulations may impact the stability and sustainability of coverage for members, a factor that should be considered when evaluating these alternatives. Key Considerations for Comparison When comparing healthcare sharing plans to traditional insurance plans, there are four key areas to focus on: Comparison to top commercial insurers. Compare these plans to top commercial insurers like Blue Cross Blue Shield, Aetna, and UnitedHealthcare to gain insights into what sets them apart and why costs differ. Provider networks. Evaluate the provider networks of both types of plans, ensuring that you have access to your preferred healthcare professionals and quality medical care. Compliance and consumer protections. Assess the required compliance to state insurance regulation, oversight, and consumer protections to ensure peace of mind in potential dispute situations. Comprehensive coverage. Compare the comprehensiveness of coverage to avoid unexpected healthcare expenses and ensure consistent coverage for your needs. Making Informed Decisions Healthcare sharing plans, while appealing at a base level due to their affordability, may not be recommended for individuals with chronic or complex health conditions. It's crucial to conduct a thorough evaluation of potential out-of-pocket costs, consider the impact of acute and chronic health conditions, and seek assistance from non-fiduciary health insurance navigators to determine the best coverage option. You can start this process by accessing resources such as Local Help Healthcare. Additionally, for independent health sharing plan comparisons, it's advisable to consult a trusted health insurance advisor who can provide personalized guidance based on your specific needs and circumstances. By understanding the differences between traditional and alternative health insurance options, and carefully considering the factors that impact your coverage and costs, you can make a well-informed decision that aligns with your healthcare needs and financial considerations. Need help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • Approach Goal Setting: Empowering Health and Well-being with a Goal Setting Template

    When faced with health problems or conditions, it's natural for individuals to seek ways to improve their well-being and regain control over their lives. One powerful goal setting template that can greatly assist in this journey is the concept of "approach goal" setting. Unlike traditional goal-setting methods, approach goals focus on the positive actions and behaviors we want to cultivate, rather than fixating solely on outcomes. Let’s explore what approach goal setting is, why it is superior to other goal-setting methods, how to implement it, and provide examples tailored to individuals with limited finances due to income and unexpected or ongoing medical bills. What is Approach Goal Setting? Approach goal setting is a mindset and methodology that revolves around identifying and pursuing positive actions and behaviors. Instead of fixating solely on the desired outcome, such as losing weight or paying off debt, approach goals emphasize the steps and activities that lead to improved health and financial well-being. By shifting the focus from the end result to the process itself, you can find more motivation, satisfaction, and ultimately, success. Why is Approach Goal Setting Superior? Focus on What You Can Control. Health conditions and financial limitations can often leave us feeling helpless. Approach goal setting allows you to reclaim a sense of control by focusing on the actions and behaviors within your reach, one action at a time. This empowers you to make positive changes, regardless of your circumstances. Sustainable Motivation. Traditional goals often rely on external motivators, such as rewards or punishments. Approach goals, on the other hand, tap into intrinsic motivation by emphasizing the enjoyment and fulfillment found in the process itself of self-improvement. This sustainable motivation keeps you engaged and committed in the long run. Flexibility and Adaptability. Health conditions can be unpredictable, and financial circumstances may fluctuate. Approach goals allow for flexibility and adaptability, enabling you to modify your actions and behaviors to meet the demands of your current situation. This ensures that you can continue progressing towards your goals, even when faced with challenges. Implementing Approach Goal Setting Identify Your Values. Take some time to reflect on what truly matters to you in terms of your health and well-being. Is it physical fitness, mental resilience, or perhaps cultivating a positive mindset? Understanding your values will help you align your approach goals with what brings you the most fulfillment. Start by focusing on one value and once you’ve achieved that, additional ones. Set Small, Specific Goals. Break down your approach goals into small, achievable steps. For example, instead of setting a lofty goal like "lose 50 pounds," focus on actions such as "incorporate 30 minutes of physical activity into my daily routine." These smaller goals are more manageable and provide a sense of accomplishment along the way. Track Your Progress. Keep a journal or use a goal-tracking app to monitor your progress. This allows you to visualize the steps you've taken and provides motivation during challenging times. Celebrate your successes and learn from any setbacks or obstacles you encounter. Seek Support. Surround yourself with a supportive network of friends, family, or even online communities that share similar health concerns. Their encouragement, advice, and shared experiences can provide invaluable support on your journey towards improved health and well-being. Examples of Approach Goals for Individuals with Limited Finances Nutrition. Instead of focusing on expensive diet plans or specific weight loss goals, adopt an approach goal centered around improving your eating habits. For example, aim to incorporate more fruits and vegetables into your meals, cook at home more often to save money, and explore affordable local farmers' markets or community gardens for fresh produce. Oftentimes, larger grocery stores will have reduced fresh produce typically in the early morning or late at night. We’ve found great deals by shopping at off times! Physical Activity. Rather than fixating on expensive gym memberships or elaborate workout routines, set approach goals that involve simple and cost-effective activities. Take regular walks in your neighborhood or forest preserve, follow free online workout videos, or participate in community sports programs. Some content creators release daily workout programs that can be customized for beginner to advanced levels. Even if you start with five minutes per day, the key is to be consistent. Stress Management. Managing stress is crucial for overall well-being. Approach goals in this area could include practicing mindfulness or meditation techniques, journaling, or engaging in low-cost stress-relief activities like reading, listening to music, or spending time outdoors. Self-care is often overlooked yet one of the most critical activities to incorporate. Approach goal setting offers a refreshing perspective on achieving health and well-being, especially for individuals facing health problems and limited finances. By shifting the focus from outcomes to positive actions and behaviors, approach goals provide sustainable motivation, flexibility, and a sense of control. Remember these three tips: Start small. Track your progress. Seek support. Celebrate each step forward. With approach goal setting, you can embark on a journey of self-improvement that is tailored to your unique circumstances and empowers you to live a healthier, more fulfilling life. Need help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • How to Navigate a Charity Care Program for Medical Bills

    Accessing affordable healthcare can be a daunting task, especially if you are underinsured or facing unexpected medical bills. However, a charity care program can provide financial assistance and ensure that necessary medical treatment is accessible to all individuals, regardless of their ability to pay. We often hear from patients that connecting to and applying for financial assistance can be challenging. The below will provide helpful information to guide you through the application process. Why Medical Providers May Not Provide Information on Charity Care Although charity care programs exist to assist patients with medical expenses, not all medical providers proactively inform their patients about these options. There are several reasons for this: Lack of Awareness. Some medical providers may not have comprehensive knowledge of all available charity care programs in their area or may not be aware of recent legislative changes that could affect their patients' eligibility. Administrative Burden. Charity care programs often involve complex paperwork and documentation requirements. Medical providers may hesitate to provide information about these programs due to concerns about the administrative burden it places on their staff. Stigma and Misconceptions. Patients may feel reluctant to discuss their financial difficulties openly, which could lead to medical providers assuming that patients can afford their healthcare expenses. Lack of Incentives. Medical providers may not have direct financial incentives to promote charity care programs. This could result in a lack of emphasis on informing eligible patients about the available assistance. Recent Laws in Illinois Regarding Charity Care and Timeline to Apply for Assistance In recent years, Illinois has implemented laws and regulations to address the issue of charity care and improve transparency in the healthcare system. These developments aim to protect patients and ensure they are aware of the available options. Here are two key laws: The Illinois Hospital Uninsured Patient Discount Act. This requires hospitals to provide uninsured patients at certain income levels with a discount on their medical bills. It also mandates that hospitals establish clear policies regarding charity care and inform patients about these policies. The Fair Patient Billing Act. This ensures that patients receive detailed and understandable bills, including information about available financial assistance programs and how to apply for them. It also prohibits hospitals from engaging in aggressive collection practices before providing patients with an opportunity to apply for financial assistance. These laws empower you as a patient by increasing transparency and accessibility to charity care programs. By requiring medical providers to proactively inform patients about their rights and available resources, Illinois is working towards a more equitable healthcare system. Time Limit for Applying for Charity Financial Assistance The time limit for applying for charity financial assistance can vary depending on the healthcare facility. However, many institutions understand the financial challenges that unexpected medical expenses can pose and provide a reasonable window of opportunity for patients to apply. It is advisable to initiate the application process as soon as possible after receiving medical services or realizing that you may struggle to pay your bills. For hospitals, the application period is typically 90 days from the date of discharge or service, while 501(c)(3) hospitals often provide up to 240 days. If you do not remember receiving information about financial assistance during your hospital stay, you may want to seek help from a family member or friend to manage the application process while you focus on your recovery. By understanding the process of accessing and applying for charity care, you can confidently navigate the financial challenges associated with healthcare expenses and ensure that you receive the vital medical treatment you need, regardless of your financial circumstances. Need help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • Empowering Patients: How to Tackle Medical Billing Challenges

    Navigating the complicated healthcare system often involves receiving confusing medical bills. A case in point is a young woman who was baffled by her bill after an annual wellness check-up. She ping-ponged between her doctor's office, the billing department, and her insurance company, struggling to understand the charges. However, learning how to tackle medical billing challenges with the right knowledge and a proactive mindset can result in a positive outcome. Healthcare providers have a significant role in ensuring billing transparency and accuracy. The billing support team, as the healthcare provider's representatives, should prioritize clear communication and provide assistance to patients. They can help you decode your bill, verify insurance coverages and exclusions before appointments and assist in understanding repayment options that won't increase your debt. Empowering patients to ask questions and feel valued not only from the clinical side but also from the financial aspect can go a long way in how you perceive service at your doctor’s office. A satisfying healthcare experience transcends just the quality of medical treatment—it also includes feeling comfortable to discuss billing issues alongside health concerns. When assessing your healthcare provider's service, consider both clinical and non-clinical aspects. Does the provider cultivate a patient-friendly atmosphere? Are your concerns addressed empathetically? Does the clinic demonstrate a problem-solving attitude towards any issues that arise? Billing errors are not uncommon and can stem from coding mistakes, inaccurate insurance benefit verification, or charges for services not rendered. If you suspect an error, here's what you can do: Review Your Bill: Scrutinize your bill for discrepancies. Ensure all billed services were received, and the costs align with your insurance coverage. Keep your insurance's explanation of benefits at hand for comparison. Contact Your Healthcare Provider: If you find potential errors, contact your doctor's billing office. Clearly and respectfully express your concerns and ask questions in a non-defensive tone. Remember, the staff is there to help you. Contact Your Insurance Company: If the billing office directs you to your insurance company, don't hesitate to reach out for clarification about your coverage and disputed charges. Keep Records: Document all your communications, including dates, people you interacted with, and any agreements made. Follow up until the issue is resolved. However, there might be instances where the billing staff is unhelpful or even disrespectful. If faced with such a situation, remember, you have rights as a patient. Here's how you can handle it: Stay Calm: Keep your cool, even when faced with a hostile reaction. Take a deep breath, validate the other person, then redirect the conversation to stay productive. Escalate: If the staff member isn't helpful, ask to speak with a supervisor. If dealing with an insurance company, try disconnecting and calling back to get a different agent. Seek Outside Help: If the problem persists, consider consulting a patient or medical billing advocate. They are professionals who can help resolve billing, insurance, or collection issues. Dealing with medical billing issues can be stressful, but remember, you're not alone. Both you and your doctor's office play pivotal roles in finding a resolution. The medical office can promote dialogue and transparency, while you can take charge by being proactive, asking questions, and seeking help when necessary. This collaborative approach can ensure fair treatment and financial stability. Need help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • The Power of Second Opinions: Navigating Your Healthcare Choices

    Navigating through critical decisions about your medical or dental treatment can be overwhelming. Often, many patients undertake the first treatment recommended by their doctor or healthcare professional. However, it's important to remember that you have choices in your healthcare treatment and sometimes, it may be beneficial to seek a second medical opinion. For instance, if you've been suggested surgery for a herniated disc in your lower back, you might not be aware of alternatives like daily stretching exercises to relieve symptoms. A second opinion can serve as a valuable tool in your decision-making process. The Value of a Second Opinion A second opinion provides reassurance, offers alternative treatment options, and can sometimes lead to a completely different diagnosis. A Mayo Clinic study demonstrated that up to 88% of patients seeking a second opinion for a complex condition received a new diagnosis that revised their treatment plan (source: Journal of Evaluation in Clinical Practice). Seeking a second opinion might seem daunting, especially when dealing with serious illnesses. However, you can empower yourself in this process by following these guidelines: Insurance Considerations Some insurance companies require preauthorization for certain procedures or treatments. You need approval from your insurance company before they will cover the cost. It is crucial to verify if a second opinion falls under this category. Document all communications to avoid future confusion or disputes. Choose a doctor who specializes in your condition within your insurance network to minimize out-of-network bills. This ensures you get the most informed advice without unnecessary medical debt. Medical Records Ensure you have all your medical records, including test results, scans, and notes from your primary doctor. These documents will provide the second doctor with a comprehensive view of your health condition. Cost Factors The cost of a second opinion can vary widely depending on the specialist, location, and your insurance coverage. Some policies may cover second opinions, while others may not. Check your coverage and plan accordingly. Navigating the Insurance System Understanding your insurance policy is key to navigating the system effectively. For employer-funded policies, check with your HR department or benefits administrator about second-opinion coverage. If you're under a government-funded program like Medicare or Medicaid, review their guidelines on second opinions. If you have a commercial policy, contact your insurance provider directly for specific information. Comparison coverage tools available online allow you to compare various insurance plans, their coverage, premiums, and other factors. As of January 2023, health insurance companies and self-funded employer plans must provide a calculator tool for their members to estimate out-of-pocket costs on a 500-item list of services and procedures (source). This list will expand in 2024. Billing Considerations Billing problems are common when dealing with insurance companies. Always cross-check your bills with the Explanation of Benefits (EOB) statement from your insurance company to ensure correct billing. Conclusion Obtaining a second medical or dental opinion is more than just a safety net; it's a fundamental part of your informed decision-making process. It promotes self-advocacy, educated choices, and better health outcomes. Don't hesitate to seek that second opinion - it could make a world of difference in your treatment journey and on your financial well-being. . Need help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • How Patients Can Give Their Medical Doctors Excellent Customer Service

    When you go to the doctor, do you think about the kind of customer service you're giving to your medical provider? As patients, we often expect our doctors to provide us with excellent care, but it's equally important that we give excellent customer service. You can enhance your medical and billing experience by ensuring your doctor and their staff feel appreciated by taking ownership of supplying excellent customer service. Here are five practical ways that patients can give their medical doctors excellent customer service while strengthening the healthcare provider-patient relationship. 1. Be Prepared for your Appointments: One of the best ways to give your medical doctor excellent customer service is to be prepared for your appointments. This means arriving on time, bringing your insurance card, ID, a list of your symptoms, medications, and questions you have for your doctor. If you are unsure what information you need, call the medical office, and ask for help. By doing this, you're making the most of your time with your doctor and helping them provide you with the best possible clinical and financial care. 2. Be Honest with your Doctor: Another way to give excellent customer service to your medical provider is to communicate honestly with them about your health or billing issues. Be transparent, telling them exactly how you feel. This means sharing any symptoms you've been experiencing, even if they're embarrassing or uncomfortable. It also means telling your doctor if you've missed any medications or have been struggling with your treatment plan. Sharing concerns with the financial team about your bill can help alleviate post appointment stress. By being honest in your interactions with the medical office, you're giving them the information they need to provide you with an accurate diagnosis, effective medical treatment and financial peace of mind. Remember, effective communication is a two-way process and oftentimes ends misunderstandings or assumptions. 3. Be Respectful of Your Doctor's Time: Doctors have busy schedules just like us, and it's important to be respectful of their time. This means being on time for your appointments and not taking up more time than necessary. Consider leaving your house earlier than usual to guarantee you arrive at your appointment on time. If you are running late, make sure you call the medical office to inform them. This helps them to keep things running on time for other patients. If you can't make an appointment, make sure to cancel well in advance, so they have enough time to fill that slot with another patient. While your doctor would also like to provide you with advance cancellation notice, it may not be possible when an emergency arises shortly before or during your appointment. Be understanding and don’t take it out on the front office scheduling team. By respecting your doctor's time, you're showing them that you value their expertise and understand the demands of their job. 4. Follow Your Treatment Plan: Another essential way to give excellent customer service to your medical doctor is by following your treatment plan. This means taking your medication as prescribed, attending follow-up appointments, and making any necessary lifestyle changes recommended by your doctor. Following the doctor's instructions will improve your chances of a quick recovery and allow your doctor to check your progress. If you don't understand the treatment plan instructions or subsequent billing invoices, ask for clarification so there is no confusion or miscommunication. 5. Supply Feedback: Lastly, supplying feedback for your medical doctor and their staff is an excellent way to give them excellent customer service. This means telling them if you've had a positive experience and offering constructive feedback if you have any concerns. By offering kind, but honest feedback, you’ll help your doctor’s practice continue improvement in delivering quality holistic care. In addition to acknowledging a pleasant experience in person consider posting a positive review online. This small gesture will not only make your doctor feel appreciated but also motivate them to continue supplying excellent medical care to other patients in the community. At the end of the day, you know how you feel when recognized – well, your doctor is human too. In conclusion, giving excellent customer service to your medical doctor is an essential part of building a stronger doctor-patient relationship. You're not only benefiting your health, but you're also becoming a better patient who is more valued and trusted by your healthcare provider. You are taking the initiative to create a positive interaction between yourself and your medical provider’s office. Remember, your medical doctor is your partner in your health, and by working together, you can achieve the best possible outcomes. . Need help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • How to Appeal a Denied Health Claim

    Managing medical expenses and denied insurance claims can be overwhelming – especially with chronic health conditions. The likelihood of you receiving a denied claim has increased. According to a Kaiser Family Foundation study, one in 500 denied claims are appealed. Don't let denials stand in the way of the vital care you need. Learn how to successfully appeal and get the coverage you deserve with these steps. 1. Understand the Denial Reason: Before you begin, know why your claim was denied. Look at the explanation of benefits or denial letter from your insurer. It could be due to incomplete information, lack of medical necessity, pre-authorization issues, or non-covered services. This understanding will be vital when building your appeal. 2. Review Your Insurance Policy: Dive into the fine print of your policy to grasp your coverage, exclusions, and limitations. Familiarize yourself with the terms and conditions, including any requirements for pre-authorization, referrals, or specific documentation. This knowledge will determine if your appeal has merit and if you have grounds to appeal. 3. Gather Supporting Documentation: Collect all relevant medical records, bills, and correspondence related to your denied claim. This includes physician notes, diagnostic reports, treatment plans, and prescriptions plus any other evidence that supports the medical necessity of the service or treatment. These documents will form the foundation of your appeal and strengthen your case. 4. Contact Your Healthcare Provider: Get in touch with the billing department where you received the services. Discuss the denial, make them aware of your intention to appeal, and gain their support. They can provide information, clear up misunderstandings, and supply additional supporting documents. 5. Follow the Insurance Company's Appeal Process: Insurance companies have specific procedures for appeals with no one insurance company having the same steps as another. Follow them closely and remain organized. Pay close attention to the deadline for submission to avoid forfeiting your right to appeal. For example, Blue Cross Blue Shield has a 365 day timely filing limit. However, you'll want to act on submitting your appeal as soon as you receive the denial while it is fresh in your mind. Explain in detail why you believe the denial is incorrect, referring to your gathered documentation for each point referenced. 6. Seek Assistance from Your Healthcare Provider: Request a letter of medical necessity from your doctor as well as supporting documentation. A well-crafted letter that addresses the specific denial reasons and provides persuasive arguments supporting the review of the denial can significantly bolster your case. 7. Understand the Internal Appeals Process: If your initial appeal is denied, most insurance companies offer an internal appeals process. This involves escalating your appeal to a higher level within the insurance company. Be prepared to provide additional documentation or any new evidence that supports your case. Follow all instructions provided by the insurance company and maintain copies of all correspondence for your records. Remember to submit requests before your insurance's deadline. 8. Seek External Assistance When Needed: If your internal appeal is also denied, or if your insurance provider does not offer an internal appeals process, you may want to take the next step and seek external assistance. Contact your state's insurance department or regulatory agency to understand the options available to you. They can provide guidance, mediation services or help you file a complaint against your insurer if warranted. 9. Facilitate an Independent Review: In some cases, you have the option to request an independent review. Independent review organizations (IROs) are impartial entities that assess the denial and make binding decisions. The IRO will review your case based on medical evidence and applicable laws. Check your insurance policy or contact your state insurance department to determine if an independent review is available to you. 10. Legal Remedies: If all else fails, and your supporting documentation firmly shows your claim was wrongfully denied by your insurance company, consult with an attorney specializing in healthcare or insurance law. Legal remedies should be a last resort due to the associated costs and time involved. An attorney can evaluate your case, advise you on the best course of action, and represent your interests in court, if necessary. Appealing a denied health claim requires patience, persistence, and a thorough understanding of the process. By following these steps, you can navigate the appeals process with confidence and increase your chances of overturning the denial. Remember to stay organized, gather supporting documentation, and leverage the assistance of your healthcare provider throughout the appeals process. Your commitment to advocating for your rights as a patient can lead to a successful resolution of your denied health claim. Need more help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • How to Negotiate Your Medical Bill: Tips and Insights

    Dealing with medical bills can be overwhelming and stressful, but you can take charge of your healthcare costs and negotiate your medical bill. With a basic understanding of the billing process, proactive communication, and assertiveness (not aggression!), you can manage your healthcare costs. Here are practical tips on how to negotiate a medical bill to achieve fair and reasonable costs for the healthcare services you receive. 1. Understand Your Medical Bill: Start by reviewing each item, service, and charge carefully and ensuring that they accurately reflect the services you received. If you receive a bill with one large charge immediately request a line-by-line itemized statement. You may find a portion of the medical jargon nonsensical. Reach out to your doctor or healthcare provider for help in converting it to layman’s lingo. 2. Verify Insurance Coverage: Major insurers provide a summary of your policy along with a detailed guide. By taking the time to familiarize yourself with the terms of your policy, including deductibles, co-pays, and out-of-pocket maximums, you can save yourself money in the long run. Be as detailed as possible when confirming services are covered by your insurance plan. Some services may have limits or are not covered under certain situations. In the case of a denied claim, contact your insurance provider to discuss any services you believe should have been covered by your insurance but were not. The provider may be able to help resolve the discrepancies with supporting evidence of medical necessity. 3. Research Average Costs: Educate yourself on the average costs of medical procedures and services in your area to assess the reasonableness of your bill. Resources such as FAIR Health Consumer and Healthcare Bluebook can be a good starting point. Obtain the CPT code for your procedure or service from your doctor and then enter the requested information. Remember, however, the average fee you see is just that, as many other factors may contribute to the final cost. 4. Contact the Healthcare Provider: Be polite, respectful, and persistent when reaching out to the billing department of your healthcare provider. Start by discussing charges and exploring potential ways to lower the bill or pay over time. 5. Negotiation Tactics: Consolidate your bills when with one provider, request an itemized bill, point out errors, negotiate prompt payment discounts, reference average costs, and offer a lump-sum settlement. 6. Seek Assistance if Necessary: Consider seeking professional assistance from patient advocacy organizations, medical billing advocates, or legal professionals specializing in healthcare. These options can offer further guidance, support and financial assistance options. 7. Financial Assistance Options: Healthcare providers may offer these services to patients who can meet specific income criteria. Apply for these programs to reduce your costs, or they may even forgive a portion of your medical bill. 8. Flexible Payment Plans: Request a payment plan that suits your budget. In most cases, providers can make allowances for patients who can't pay the bill in full. 9. Communication Log: Keep an organized and detailed record of all communication with healthcare providers, including dates, names of individuals spoken to, and a summary of the conversation. This documentation can help you track your progress and offer evidence if needed in the future. Remember, always prioritize your health and well-being, as each negotiation scenario is unique, and results may vary. But, by taking an active role in negotiating your medical bill, you can potentially save a substantial amount of money. With effective communication, persistence, and self-advocacy, you can expect to increase your confidence. Healthcare providers understand the challenges associated with medical expenses, and many are willing to work with patients to find reasonable solutions. Negotiating your medical bill is an empowering step towards effective healthcare management. By understanding your bill, verifying insurance coverage, conducting research, employing negotiation tactics, and seeking assistance when needed, you can navigate the process with confidence. Remember, healthcare costs are not set in stone, and with persistence and effective communication, you can achieve a fair and reasonable resolution that eases the burden on your finances. Need more help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • Stop Overpaying on Medical Bills Now

    In a recent survey conducted by YouGov, almost 40% of adults find medical bills confusing. As a healthcare consumer, it is important to understand how to spot errors and discrepancies on your medical bills to save time and money. How to Spot Errors and Prevent Overpaying on Medical Bills The best way to avoid overpaying on a medical bill or due to incorrect billing is through proactive measures. When you receive a bill from your healthcare provider, review it thoroughly. Patient statement bills can be overwhelming to read, as they contain technical language and abbreviations that may be unfamiliar to most people. Statements should be simplified with the necessary information to make it easier for you to pay. It’s important to understand what is included in these statements as it will allow you to accurately track your expenses and identify any discrepancies in billing. Common key items on patient statements include: Service date. Procedure codes – you may see several line items comprised of numbers and or letters. Each procedure code corresponds to a specific type of service or product provided by your healthcare provider (i.e. office visit, lab test, screening, etc.). These codes are used by insurance companies to determine how much they will cover for each service provided. Finance/interest fees, late charges. Patient payments. Insurance adjustments and payments. Balance due. Payment due date. Where to mail your payment. Online payment option. Look for any discrepancies between the services that were provided and what was billed. Common errors that happen: Duplicate charges. Sometimes providers will accidentally add multiple charges for the same item which can result in an overcharge. You could unknowingly overpay if the bill was not reviewed. Services not received. This is a test or procedure that was not performed but incorrectly added to the bill. Incorrect payment terms and dates. If there are any discrepancies between what was originally discussed with your provider and what appears on the bill, contact them right away so that they can help resolve the issue quickly and efficiently. Inaccurate balance due. Compare the total sum of what you owe with any copayment amounts, previous patient and or insurance payments. This will help ensure the balance ties out accurately. Balance billing. This is when you are charged for a balance that should not be your responsibility. It’s also important to understand what your insurance company covers. If there are services listed that you know should be covered by insurance but aren’t, this could be an oversight or error in billing. If you see something that doesn’t look right, contact the billing department immediately and explain the issue. Before you schedule any appointments or procedures, check with your doctor and your insurance company first so you can get an estimate of how much will be billed for each service performed and expected coverage. This way, you won’t have any surprises when the bill arrives later down the line. Additionally, always double-check the accuracy of information such as dates of service and codes used for medical procedures. Small mistakes can add up quickly and create problems later when figuring out what went wrong and obtaining a resolution. If You Do Receive an Incorrect Billing Statement If you do receive an unitemized, confusing, or incorrect statement from your healthcare provider, keep calm! The first step is to contact them directly and inquire about any discrepancies in the bill—this is often all it takes to resolve the issue quickly and accurately. If this doesn’t work, contact your health plan administrator for assistance resolving disputes with providers or insurers over claims or payments (they may even offer help with filing appeals if necessary). We have heard, however, some administrators place the burden back on the patient or follow through doesn’t happen like it should. When this happens, stand firm and keep on top of the situation. You may have to initiate follow-up more often than you think necessary. If all else fails, do some research into local advocacy programs in your area—many areas have these types of resources available specifically designed to help patients navigate complicated billing statements and other issues related to healthcare payments and collections. It's critical that patients review their bills carefully before making any payments. Errors could mean hundreds of dollars in unnecessary costs that come out of your pocket if not caught early enough! Fortunately, there are steps you can take both before receiving a bill (checking coverage options before scheduling services) and after (contacting the provider directly) that can help save both time and money while avoiding potential headaches caused by inaccurate billing statements. When dealing with healthcare collections issues due to inaccurate billing statements, remember—you don't have to go it alone if you don’t want to or don’t have the time! Resolving a problem bill can take a couple of hours of phone calls to over one month plus – it depends on the billing issue complexity and response time of the other party. Still, it’s always better to reach out directly, to be persistent and follow up regularly - rather than risk paying more than necessary. Being informed about your rights as a patient and knowing exactly what should appear in your statement will go a long way towards making sure you are able to confidently self-advocate. Need more help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • How to Get the Most Out of Your Medical Billing Dispute Case in Illinois Small Claims Court

    You’ve exhausted all your options in getting your medical billing dispute resolved. The next step may be filing a small claims case in Illinois (or your resident state as each state has their own process); you may feel overwhelmed and uncertain of what this entails. Fortunately, it can be straightforward with the right preparation and provides simplified rules for a faster conclusion. Learn what you need to know about filing a small claims case in the state of Illinois. (Disclosure: This is not legal advice and is presented for general information purposes only.) Steps for Filing a Small Claims Case in Illinois The first step to filing a small claims case is to fill out the complaint form which is also available online at the Illinois Courts website. This document outlines your complaint and states why you are seeking damages from the other party. Make sure to provide as much detail as possible on the form so that your claim is taken seriously by the court. It’s also important to include all relevant information such as names, addresses, contact information, dates, etc. Once the form is filled out, file it with the appropriate court (usually local or district) and pay any necessary fees associated with it. What You Can Expect from The Process Once your claim is filed, it will take up to four weeks or more for a hearing date to be set. During that time period, both parties involved will receive notice of their hearing date and will have an opportunity to work out their differences without going through litigation if they prefer that option. On the day of the hearing both parties must attend court and present their arguments in front of a circuit court judge who will make a decision based on evidence provided by both sides. Depending on how complicated and disputed each side's arguments are, this process could take anywhere from 15 minutes up to two hours or more. Small claims court proceedings generally are speedy and based on a maximum claim dollar amount of $10,000.00. Individuals may or may not choose to have legal representation. But consulting with an attorney who specializes in healthcare law or medical billing disputes before going into court can provide you with legal strategies that will help support your position during trial proceedings. Remember, though, you are making an investment of time and money and your case may take many months to years to complete. Carefully consider this before filing a complaint. If you want to see court action prior to formally filing a complaint, you can sit in on court sessions as they are open to the public. Presenting Yourself in Small Claims Court: Tips for Success Presenting yourself in small claims court can be intimidating if you don’t know how to prepare. It’s important to remember that presentation matters. Dress appropriately, speak clearly and calmly, and remain composed throughout the proceedings. Make sure that all documents and information necessary for your case are organized and accessible. This includes any paperwork such as medical bills, insurance statements, receipts, and other relevant documentation related to your claim. You may also want to bring notes about your side of the argument so that you don’t forget any important points during the hearing. Make sure that all material is clearly labeled and presented in chronological order so that it is easy for the judge and other parties involved in the case to understand what is being presented. Tips For Getting Your Case Resolved Quickly and Efficiently When arguing your case in small claims court, it’s important to keep everything concise and on point. Stick only to facts relevant to your case. There is no room for irrelevant information, emotional outbursts or personal comments about other parties involved in the dispute. Also be respectful at all times and come emotionally prepared! Do not raise your voice or argue with others (including the judge). Speak slowly and clearly so that everyone in attendance can understand what you are saying. Finally, avoid using legal or medical jargon. Instead use simple language to avoid confusion so that everyone can understand exactly what happened and why you believe you should win the case. Showing up prepared with all the necessary evidence will also help make a strong impression on the judge who will ultimately decide your case. It’s also important to know exactly what you’re talking about before going to court - which means doing your research ahead of time. Make sure you understand each piece of evidence you plan on bringing up so that there is no confusion about why it is relevant or how it applies to your argument. Being knowledgeable about what happened will help ensure that you don’t get caught off guard during questioning from opposing counsel or the judge overseeing your case. Be sure to include any relevant evidence or citations whenever possible. This adds credibility to your argument and helps support each point made throughout proceedings. Use original content rather than a document you created yourself. An example would be screen shots or print outs of medical procedure costs supporting your case or complete definitions of procedure or service medical codes. Be sure to include source, date and any other verifiable information substantiating your point. It's important to understand your rights as a patient before going into a small claims court hearing. In Illinois, fee-based hospital patients are protected under the Fair Patient Billing Act to receive fair billing and collection practices while Illinois Public Act 096-1523 protects against surprise medical bill balanced in situations as described in the Act. Familiarize yourself with laws relevant to your particular case and be prepared to explain how those laws support your position in court. Doing this will give you an edge over other parties involved in the dispute who aren’t as familiar with applicable laws or regulations related to their issue. Additionally, knowing your rights will help ensure that justice is served by preventing any party from taking advantage of another due to lack of knowledge about applicable laws or regulations related to their issue. Research the background, qualifications and records of the opposing party and the judge assigned – especially as it relates to your specific dispute. Things you will learn include how experienced they are with this dispute type, typical rulings on like kind cases and past verdicts. Using Expert Witnesses in Medical Billing Disputes You may find it extremely helpful to gather expert testimony from medical professionals who are familiar with the procedures and services at issue in your case. An expert witness can provide valuable insight into the facts of the case to the court. What is Expert Witness Testimony? An expert witness is a person who has specialized knowledge or experience with a particular subject matter. In the context of medical billing disputes, an expert witness may be someone who has extensive experience working with medical billing and insurance companies, such as a former billing manager, health insurance vice president or high level coder. Medical experts are typically called upon to provide their opinion on matters related to the patient's treatment plan and whether or not it was appropriate for their diagnosis. An expert witness should have no financial stake in the outcome of your case—if they do, their credibility could be called into question by opposing counsel during cross-examination. The Benefits of Expert Witness Testimony Having an experienced medical professional testify on your behalf can be invaluable when trying to resolve a medical billing dispute. An expert witness can explain complex concepts and concepts in language that the court can understand, which can make it easier for them to understand the nuances of your case. Furthermore, if the opposing party attempts to discredit any part of your testimony, an expert witness can provide validation for any statements made by you or other witnesses in court. The expertise provided by an expert witness can also serve as leverage when negotiating a settlement outside of court. Having an experienced medical professional testify on your behalf as an expert witness can give you the edge needed to win your case in Illinois small claims court—and ultimately get you the reimbursement that you deserve! Conclusion Filing a small claims court case can be an intimidating experience, but if you take the time to prepare properly, it won’t have to be stressful or overwhelming. Be sure to gather all relevant evidence ahead of time, organize it neatly, and know exactly what points you want to make before going to court. Presenting yourself professionally with confidence is essential for making a good impression on the judge who will ultimately decide your fate! By using these tips, you’ll feel more confident heading into a small claims court hearing, knowing you did everything to prepare yourself for success. Need more help with resolving a medical or dental bill issue? Contact your area's local patient advocate or reach out to MBCR today!

  • Unpacking Surprising Medical Bills and Statements

    Receiving a medical bill or statement can be overwhelming – especially when it is unexpected. You may not understand why you are receiving a bill to begin with let alone the charges, what services are included, or why it’s more expensive when you are aware you would incur a cost sharing balance. To help you make sense of a surprise medical bill and statement, let’s break down what you need to know. Understanding Your Patient Statement Your patient statement is a summary of all the services you received from your doctor or hospital visit. It includes a list of the treatments and medications that were administered to you during your visit as well as any additional fees for lab tests, supplies or equipment used in your care. These services may have been provided by multiple providers and billed under a single master bill or sent individually resulting in multiple bills. Some providers send a summary total while others give an itemized breakdown. This can include how much each service costs and any insurance coverage applied towards the total amount due. There are several key elements you should be aware of. First, look at the payment due date on your statement as this will determine when payment is due on the balance owed. Next, look for any fees or charges that have been added to your bill since the last one was issued. These additional fees could include late fees or interest charges. One of the documents you probably signed when you were a new patient is the healthcare’s financial policy that lists the additional fees and under what circumstances you would incur these on your account. Lastly, make sure to check for any discrepancies in billing codes or rates as this could indicate potential errors in billing practices by the health care provider. It can feel like you are bombarded with bills. A typical provider sends a minimum of three billing statements. Don’t ignore them because your patient statement is intended to give you an understanding of the services rendered and charges incurred during your visit. Understanding Surprise Medical Bills Surprise medical bills are unexpected charges that are not covered by insurance like copayments, coinsurance, deductibles, out-of-network care providers, and other fees charged by certain specialists. An out of network balance happens when you receive services or treatments from a provider who is not contracted with your insurance plan. In some cases, surprise bills may cost hundreds or even thousands of dollars depending on the services provided. They are usually much higher than what was initially expected, leaving you feeling confused and frustrated. The amount owed will depend on the specific procedure performed as well as any additional fees associated with it such as anesthesiologist fees or laboratory tests ordered by a specialist. It's important to review your patient statement carefully to ensure that all charges are accurate and correspond to the services you received and that no surprises have been added on without your knowledge. It is important to understand that surprise medical bills are not uncommon and can happen even if you have insurance coverage. Minor to major medical billing errors happen due to human error, medical coding changes, coding modifiers (provides additional explanation for a service, supply or procedure) and insurance payment rule or coverage changes. Other causes affecting the accuracy of a medical bill could include antiquated technology and inaccurate claims assessment affecting the amount of a patient’s claim payment. At the federal level, the No Surprises Act went into effect in 2022 for the majority of patients enrolled in an individual or group health insurance policy. It provides additional patient protection beyond state laws for certain situations that result in a surprise medical bill balance. Such scenarios include an emergency room service provided by an out of network provider or facility without prior authorization, out of network supplemental care by out of network providers working in an in-network facility and air ambulance services from an out of network provider. Medical billing practices vary from state to state but most states do have laws in place to protect consumers from surprise medical bills and unreasonable fees. In Illinois, House Bill 4703 expands upon the protections of the No Surprises Act by extending its prohibition against balance billing to all non-participating facility-based physicians providing services at an in-network hospital or other facility, not just radiology, anesthesiology, pathology, neonatology and emergency physician services covered under the federal law. Additionally, it requires health care facilities to provide certain information about network providers on their websites and other materials. While the law may appear cut and dried, there are exceptions to be aware of which could leave you with a balance. Illinois protections are only available if you are enrolled in a state regulated health insurance plan and the provider is based within an in-network facility. If either of these two criteria is not met, you may be subject to receiving an unexpected bill due to charges incurred outside your network. Keep in mind that any intentional selection of a nonaffiliated health care professional could result in additional charges which are not protected under existing regulation. As a patient and consumer of medical services, it's important to familiarize yourself with laws such as these so that you know your rights when it comes to negotiating with providers for lower rates or appealing disputed charges. Additionally, many health insurers offer resources for patients who need assistance understanding their medical bills and navigating their insurance coverage options. Be sure to research which providers are within your approved insurance network so that you can avoid any unwelcome financial surprises. Receiving an unexpected medical bill is never pleasant but if you take time to review your patient statement line by line, you can better understand why the bill was higher than expected and take steps to address it if necessary. If you receive a bill with one total, you have the right to request an itemized bill and you should. Knowing your rights as a consumer is key when dealing with surprise medical bills. To learn more about the No Surprises Act, visit the Centers for Medicare & Medicaid Services site for a brief fact sheet.

  • What to Do When You Use an Out-of-Network Dentist Accidentally

    Accidentally using an out-of-network dentist is an expensive hassle. You thought your dentist is in-network, benefits were verified and you received an estimate from your dental clinic of projected out of pocket. But then, you receive an unexpected dental bill in the mail or electronically. The teeth removal or whatever dental care you had a couple of weeks ago wasn’t covered by your insurer. It turns out your dentist is now out-of-network and maybe even your clinic. Now, you’re required to pay an outrageous balance bill you can’t afford. Well, you’re not alone. This scenario happens more often than you think. And fortunately, the situation can be resolved. Read this post to the end to find out what to do when you accidentally use an out-of-network dentist. First, Why is Your Dentist Suddenly Out-of-Network? This question is the first thing that would come to mind when you get a surprise dental bill. Here are two main reasons your previously in-network dentist is now out-of-network. 1. It Might be an Error Yes, your dentist may not be out-of-network after all. An error might have occurred when your dentist filed the claim with your insurer. Thus, resulting in a wrong balance bill. For instance, if there is a coding mistake or the service level is different than what was estimated. Say you had your teeth polished, but it was mistakenly coded that you had braces done. You’ll be sent a surprise balance bill if your insurer doesn’t cover braces in that dental clinic. Tip: Review your balance bill to ensure there’s no error in the list of services you received. And check your insurer’s explanation of benefit (EOB) to confirm your coverage. 2. The Dentist’s Contract Expired Dentists are in-network when they sign a contract with an insurance company. The insurer brings them patients, while they agree to charge a subsidized fee for their services. Your previously in-network dentist can suddenly be out of network if their contract with the insurance company has expired. Perhaps they couldn’t agree on mutually beneficial terms or the renewal contract deadline was overlooked. Tip: Always double-check to see if your dentist is still on your insurer’s in-network lists before receiving dental services. Dentists often forget to update patients on their network status. How to Resolve Out-Of-Network Dentist Bill Issues When you mistakenly use an out-of-network dentist, there’s hardly anything your insurance company can do about it (except if there was an error). However, you can speak to your dentist to resolve the dental bill issue. Request a waiver for disallowed charges. Disallowed charges are the extra charges on top of what your insurance is willing to pay. Say your insurance pays a max of $1,000 for teeth polishing, but the dentist asks for $1,500. The extra $500 is the disallowed charge. You can ask your dentist to write off the disallowed charge. Since you’ve been an in-network patient with the dentist, they should be willing to waive the extra charge. Negotiate your dental bill issue. If your dentist isn’t willing to waive the disallowed charges, try negotiating. You can agree on the percentage of the balance you can pay conveniently. Or negotiate a plan to pay the balance bill over a period. Another tip is to negotiate a prompt pay discount if you can pay the balance in full in a single payment. Get billed as an in-network patient. Lastly, your dentist can continue to bill you like an in-network patient. That is, they will bill you the same amount they would if you were in-network. So, your dentist would get paid by your insurer, and you won’t be balance billed. Why Would Your Dentist Agree to These Resolutions? You're probably wondering why your dentist would agree to waive disallowed charges, negotiate your balance or bill you as an in-network patient. Well, businesses, including dental clinics, don’t like losing customers. And, you’ll likely leave their practice to use an in-network dentist if the issue isn’t resolved or if you've had less than satisfactory customer service in the past. So, your dentist would do whatever it takes to ensure you keep patronizing their clinic for your dental care. Reasons Out-of-Network Dentist Bills Are Outrageous If it’s possible to resolve an out-of-network dentist bill by paying a lower negotiated balance, why are the bills so outrageous in the first place? Here are two reasons you receive a huge balance bill when you use an out-of-network dentist. More expensive charges. Out-of-network dentists’ costs are more expensive because they are free to charge whatever they want for their services. Unlike in-network dentists, who may charge a more reasonable cost negotiated with their insurance companies. For instance, an insurer may negotiate $600 for a tooth removal with an in-network dentist. And the same dentist can charge an out-of-network patient double or more. Lower insurance coverage. Preferred Provider Organization (PPO) insurance plans cover services received from both in-network and out-of-network dentists. But, the plan covers less percentage of the dental cost at out-of-network clinics. For instance, your insurance plan may cover 80% to 100% of the cost of your dental care received at an in-network dentist, and less than 50% at an out-of-network dentist. Some plans also have a deductible, even on routine prevention care, that must be met first before benefits are paid. Resolve Out-of-Network Dental Bills With Your Dentist Accidentally using an out-of-network dentist can lead to an unexpected dental bill. But, it doesn’t have to result in bad debt that affects your financials. You can resolve the bill by discussing the situation with your provider. And remember, just because you’ve been using the same dentist forever and they’ve always been in-network doesn’t mean things can’t change. So, always verify that your dentist AND clinic is still in-network before receiving dental care. Need more help with resolving dental bill issues? Contact your area's local patient advocate or reach out to MBCR today!

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