Medical Billing and What You Don’t Know

Medical Billing and What You Don’t Know

Medical billing is a lot more involved than you think. So, if you think all you do is hand over your insurance card you better think again & read this. Now.

Medical Billing and What You Don’t Know is the title of this article. The “What You Don’t Know” will probably come as a huge eye opener. And a huge eye opener to a majority of readers at that. Believe me, when I say what you don’t know about hospital billing is important.

Because, it is very important.

Medical billing is something that holds some potentially expensive pitfalls. This article covers two of them. Not in detail but sufficiently so you won’t fall into their traps.

Medical Billing and What You Don't Know

We all have experienced what seems like a mountain of forms you have to fill out when you go to a clinic, urgent care, hospital or doctor’s office for the first time. The problem is we don’t read all of them. We just fillin the boxes and sign or initial on the marked lines.

A Quick Personal Experience

So, I had occasion to use the services of a clinic I have never used prior to the morning learned this neat lesson. Like all clinics they give the new patient anywhere from 4 to 6 pages and/or forms to complete. It’s the usual stuff. Name, address, phone number, email, contact person, types of medication you are using and primary care physician. As well as a list of medical conditions you check if you have that particular condition or conditions.

Which is why most people believe the only requirement is to present their insurance card and the clinic does the rest. No surprises, right? The first surprise however for most of us is the block labeled social security number. Most people simply fill it in. I never give them my number. And I do give them my insurance cards.

Ahhh, but wait, there is a surprise. Read the forms and you will see the burden is actually on you. They list it as your responsibility for making sure the provider is paid by the insurance company. 

Wait a minute, did I just say what I think I said?

Your insurance cards have all the necessary numbers for the clinic to be reimbursed. They do not require your social security number. In fact, if they do have it, they must have a social security number safeguard policy in place and give you a copy of that document upon request.

This is required by a provision in USC 42. USC isn’t the University of Southern California in this case, it is the United States Code. This is going to serve as the first piece of the medical billing and what you don’t know. Moreover, it is packing a whammy that surprises, if not shocks and befuddles, most patients.

The second piece of the medical billing shock story is something called courtesy. Yep, good old fashioned courtesy. How can courtesy be something you don’t know? You’re courteous to everybody.

Easy. Like so many of us, you didn’t read the medical billing form. You simply initialed and signed on the marked lines and assumed your handing over your insurance cards was all that was necessary. Once again, like so many of us do and have done. In almost every case that is correct. However, in some cases, the patient not only has to deal with the illness but the insurance payment process.

It works like this. If you had read the medical billing form you most likely would have seen words to the effect:

*This clinic bills your insurance out of courtesy to you. You’re responsible for payment and any follow up necessary to complete the payment.*

What?

You read that right. Surprise, Surprise!!

You are responsible because there are no laws that shift the responsibility on to the clinic to attempt to collect the money owed. Hence, the clinic is providing a courtesy to the patient. They do it because they want to get paid as soon as possible. That part isn’t a surprise, right?

Hard to believe in this day and age no law like that exists but true. That is one aspect not talked about in the current health care debates. It would seem like if you paid your premiums and your coverage is in force and you gave the front desk clerk your cards your part should be over.

Like I said, in most cases, that is the end of the story. The clinic’s insurance manager submits the forms to the company and the clinic waits for payment. You do not know if or when the payment will be made but you did your part. At least according to how it has always worked in the past.

This is the second medical billing. And what you don’t know that could potentially raise its ugly head and cause you a heartache. Pay attention to the forms. So you can ask questions while you are standing at the front desk.

Trust me, you will sleep way better if you do.



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