Over at USA Today they have a helpful list of reasons why your insurance company may not be paying your medical bills and the remedy is basically that sick people should aggressively monitor, research, and follow up on every single health care interaction.
You need to be very knowledgeable and diligent to not be screwed. Just because a providers says they “accept your insurance” doesn’t mean they are in your network. For example here is their advice on how to handle a disagreement between your hospital and insurer about how multiple procedures have been bundled together:
Bundling cases are interesting, because sometimes, the doctor is correct, and sometimes, the insurance company is correct. These cases require research into the billing codes used, what occurred during the procedure, and the specialty’s (i.e., orthopedics vs. cardiology) standard billing practices. If you have a complicated bundling issue that has lead to massive bills, you might consider hiring a medical billing advocate for professional help getting your bill resolved.
This is not a new problem, but it is deeply disappointing “health care reform” didn’t attempt to fix this. The core structure of the Affordable Care Act was to keep the dynamic between one sick person and big powerful corporations in the name of “consumer driven” innovation.
Individuals are expected to understand every term and clause of multiple insurance policies to choose the right one every year, shop around for the best hospitals, make sure their providers are doing everything in accordance with the insurance rules so they don’t get hit by unexpected costs, constantly update their exchange with any change in their income, and track that obscure billing codes are handled correctly by all sides.
We expect people with little health insurance literacy to do this all when they are at their sickest and most vulnerable. Sick people make bad watchdogs and personal advocates.
I think the advices USA Today gave is good but it shouldn’t be too much to ask for a health care system where this level of diligence isn’t necessary.
Photo by Sergio Alvarez under Creative Commons license