Handling a Handle a Health Insurance Claim Dispute

Health insurance companies can be a pain when you suddenly get an unpaid medical bill that you know should have been covered. Sometimes, medical offices bill the visit wrong or the medical reason code is incorrect. Whatever the reason a bill is sent to you for a medical visit, whether is be a hospital visit, a doctor’s office visit, or an emergency room visit, you should know and understand how to get that bill paid for by your health insurance company. Here are some tips for dealing with a health insurance company to pay the bill so that you are not left with an outstanding balance.

Call the doctor’s office or hospital to see if a mistake was made when submitting your claim. Sometimes your health insurance information is recorded incorrectly or has not been updated with the medical facility. Contacting the medical facility, whether it be the physician’s office or hospital, can help to alleviate any unpaid bills that should have been covered by your health insurance company. Verify that your correct health insurance policy is on file and give the medical facility a copy of your insurance card so that the same mistake does not happen again. Sometimes an unpaid medical bill comes simply from the medical facility not having the right information on file. Be sure to also verify that your name and address are correctly on file at the doctor’s office or hospital to prevent the same insurance confusion the next time. Be sure to do this for all members of your family that are covered under this same health insurance policy.

Call the health insurance company yourself. Often times, a medical facility changes the way they bill visits or outsources for physicians who bill on their own, separate from the medical facility. I recently had a bill come from a company called Exigence that said I owed $75. That was not the hospital name I visited on the date of the bill. Instead, Exigence is a company that my hospital hires from to get physicians into the emergency. The company of Exigence bills the health insurance company itself. Because they bill differently, a check is actually cut to me that I have to cash and send to Exigence from my health insurance company. I did not know any of this until I contacted my health insurance company and found out this information. So, I had to wait for a check to come from my insurance company to pay the Exigence physician. It’s important to know who is getting the money and where it needs to be sent if a medical facility bills differently from outsourcing medical staff.

Understand what your co-pays and deductibles are for your health insurance. If you get an outstanding bill from a medical facility, it may be because you must fulfill a deductible for the insurance company or owe a co-pay to the medical facility. A co-pay is money that you are left to pay after the insurance company is billed a certain amount. It’s usually a percentage of the bill that the health insurance company won’t pick up. A deductible is an amount that you must fulfill in order to start receiving health insurance benefits. Once a deductible is paid, out of pocket, then your health insurance company will begin paying all or a portion of your medical visits, depending on your policy. Be sure to find out and understand what, if any, co-pays and deductibles you have for your health insurance coverage. Contact your health insurance company if you are unsure of any amounts you must pay upfront. You should receive statements in the mail from your insurance company that show how much of a deductible you have and how much you have paid so far. The amount of the co-pay you’re expected to pay should be written on your health insurance card.

Helpful Hints & Tips:

Contacting your health insurance provider is easy…simply call the number listed on the back of your health insurance card, provide your name, policy number, and group number…you will usually be required to verify your date of birth and social security number. Remain calm when receiving an outstanding medical bill…there is usually a good explanation for it…and if a mistake is made, it can usually be reconciled easily with a little patience.