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Every
time I go to the grocery store, I check my receipt to
make sure I was properly charged for my honeycrisp
apples and cereal. But when it comes to medical care, I
have no idea what medical procedures should cost.
On the
rare occasions that I receive a detailed bill, I can
barely decipher the billing codes and insurance lingo.
It makes me want to scream: "Why do they make it so
complicated?"
I didn't
get a good answer to that question at
Unity Hospital's
new medical bills seminar. But I do have a better grasp
on how to read my medical mail and pay for my care.
Unity is
a hospital in
Fridley, Minn.
, that's part of the Allina system. Unity's financial
services manager,
Fran Hakim
, came up with the idea for the bills seminar to address
questions she and the other financial counselors hear
day-to-day. Unexpected medical expenses on top of an
injury or ailment can be overwhelming, Hakim said.
After an
appointment or hospital stay, the first piece of mail
you'll typically receive is the infamous "this is
not a bill" — though it certainly looks like one
— document from your insurer.
This is
called your explanation of benefits (EOBs) and it is
confusing because it lays out the dollar amount of the
original insurance claim (the sticker price), the
payment amount that the insurer and hospital have agreed
upon (the discounted price) and the amount a patient
must pay. Don't even try to understand how all the
numbers jibe. Just look at the amount you are expected
to pay, which will be listed in a category called
"amount owed," "patient
responsibility," or the like.
Don't
pay, because, remember, this is not a bill.
Bills
come later from the hospital or health care provider.
Don't be surprised if you get more than one, even for a
single appointment or hospital stay. You will get two
bills, for example, if the emergency room doctor you see
is not employed by the ER you visited, Unity's
Amy Perry
explained. Have an X-ray taken, and you will see a bill
from a radiologist, even if you never set eyes on the
doctor who read your film. You might see a bill for that
ambulance ride, too.
Bills can
come months after the service, and it's hard to know
whether you've received each and every one. Call your
insurance carrier if you're unsure, because companies
will submit a claim to your insurer first.
It would
be nice if all bills and EOBs looked the same. But they
don't. On every piece of paper, check to make sure that
the date of service is accurate, that you are being
billed for services at a location where you've actually
been a patient, and that the services you're being
billed for sound familiar, Hakim said. If the summarized
bill lacks sufficient detail, ask for an itemized bill.
But with the complex insurance codes and medical terms,
good luck figuring that out.
Still
confused? Pick up the phone. As more patients face
out-of-pocket costs in the form of higher deductibles
and co-insurance, health care providers are staffing up
to help them understand the medical mumbo jumbo.
North Memorial Medical Center
, for example, is hiring three more patient financial
advocates to help the existing two meet demand. Unity
plans to offer its seminar again and is customizing it
for pregnant women and others. It can also be viewed
online at http://www.allinaunity.com.
Finally,
do some research before setting foot in a doctor's
office.
With open
enrollment coming, let history be your guide. Now is the
time to evaluate how much you've spent on health care
this past year. You may find that you'd be better off
with a high deductible plan instead of co-insurance or
that you should have opened a flexible spending account
— where a portion of your pre-tax paycheck is set
aside to pay for qualified medical expenses.
If you're
getting an elective procedure or something else you can
plan for (as opposed to being transported in an
ambulance, sirens blaring), look up prices in advance.
Health care professionals are getting used to consumers
asking for a cost estimate before a procedure. You can
also compare prices online. Check out http://www.mnhospitalpricecheck.org
and http://www.mainstreetmedica.com.
———
ABOUT THE
WRITER:
Kara McGuire
is a columnist for the
Minneapolis Star Tribune
. Readers may send her e-mail at kmcguire@startribune.com
or follow her on Twitter at www.twitter.com/kablog.
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