This page is dedicated to people who have health insurance but yet received unexpected medical bills. If you do not have healthcare coverage and are struggling with medical bills, click here for more resources

 

Step 1:

STOP – Don’t panic or make payment just yet. Who is the sender? If it is from your insurance company, it is not likely a bill. If it is from a healthcare provider, verify if the name of the patient, date of service, and the services performed to make sure you did receive the care. Always ask for an itemized bill and wait until you receive the Explanation of Benefits (EOB) before making payment or arrangement.

Step 2:

Review the EOB to make sure the insurance company processed your claim correctly, and the “Patient Responsibility” amount matches the bill you received. If the “Patient Responsibility” is lower than what you are billed for, inform the provider billing department immediately – the provider may be overcharging you, unlikely intentional, but the insurance company might have under paid the provider due to claim processing errors.

Even when the “Patient Responsibility” matches with the amount billed by your provider, verify if the claim was processed correctly by your insurance company. Have your Annual Deductible been met but the EOB indicates otherwise? Is the Copayment and Co-insurance calculated correctly—Primary Care VS Specialty Care, In-network VS Out-of-network, etc.

Step 3:

If the claim was not processed correctly by your insurance company, or if you are not 100% sure it was correct, call the customer service department phone number as shown on your insurance card or on the EOB. The customer service representative should be able to explain your benefits and review if the claim was processed correctly. If they need additional time to review the claim, they will provide a written response when the review is complete. ALWAYS document ALL communications between you and your insurance company/provider. Note the date, time, name of the person you spoke with, the outcome/next step, and case reference number.

Step 4:

Keep the provider informed of your communications with the insurance company. Let them know the claim might have been processed incorrectly and you are working with them to resolve the issue, so your provider can put a pause on your outstanding balance. When the claim is being reprocessed for additional payment to your provider, your provider will send you an updated bill.

Step 5:

Do you agree with your insurance company’s determination on your financial responsibility? If yes, proceed to Step 6. If no, you can file a Grievance with the insurance company. You should have good reasons and proof that the claim was processed incorrectly. You must file Grievance in a timely manner (usually within 90-180 days) for it to be considered.

Step 6:

Once the true “Patient Responsibility” has been confirmed, explore your payment options. Most physicians and hospitals accept installment plan without charging interest. Instead of putting the balance on your credit card, take advantage of zero interest installment plans. If you simply cannot afford what you owe, inform the physicians/hospital of financial hardship, with proof. They may be willing to give you a discount. Note that without Proof of Financial Hardship, it may be illegal for physicians and hospital to waive or discount your financial responsibility if your insurance company has already paid for part of the claim.

Step 7:

If things get too complicated and you are completely overwhelmed to handle it on your own, Contact Us for a free consultation, we maybe able to help.