Having an illness or injury can be frightening and confusing. There is almost an entirely new language that you are not familiar with. Suddenly, you are thrust into an environment that is foreign to you, and you become fearful of making a mistake. Then the medical bills come in and you feel the exact same way all over again.
Millions of Americans do not have health insurance, which is a critical issue for our elected officials and our business communities to face. However, having health insurance is not a panacea for all your medical woes. Here are some factors to keep in mind when you are dealing with doctor and hospital bills:
If possible, call ahead to a doctor or hospital that you plan to use to confirm that they accept your insurance. Specify what type of insurance you have, not just by national name, but by the local product that you purchased. For example, GHI has several variations of programs, some of which Fox Hospital accepts and some it doesn't. So, don't just say you have GHI and assume you are covered. Also, check with your insurance carrier to see if your service is covered or authorized and if the provider or facility you will use will also be covered. Please remember that acceptance of insurance does not mean that a patient will not have any financial responsibility for the service.
Understand that you will be getting separate bills from the hospital and the doctor, such as a bill for the radiology study and a bill for the interpretation of that study from the radiologist. If you visit the Emergency Department, there will be one bill for the ED itself and a second one for the physician who treated you.
Your co-pay is part of your contract between you and your insurance company. You cannot ask your provider or the hospital to violate that contract by waiving the co-pay for a visit.
The amount of a bill left over for you to pay after a service is a matter between you and your insurance company. The company tells the hospital how much they will allow for any given service. We deduct that from the cost of that service, and the remainder is your responsibility.
Most hospitals, including Fox, have patient assistance programs for those who have trouble paying medical bills. The important thing is to bring it to someone's attention very early in the process, like during registration. If the criteria are met, medical costs may be reduced.
It is also very important to complete the application and return all required documentation promptly. In some instances, there may be time limits.
If you are having trouble paying for prescription medications, the best people to talk to are in your doctor's office. Drug manufacturers have programs to assist patients with drug costs. The office will have the forms needed to apply for those programs, and will often run interference for you with those companies.
Often, you will have questions about a bill you get from a hospital or doctor. Call the phone number on the bill. It is helpful to write down the name of the person you speak with, in case you have to call again. If you would like an itemized bill of all the services, you may request this by calling that same number.
Other good things to remember are to bring your most current insurance cards with you at every visit to the doctor or hospital and verify your most current billing information. It is important to respond to all requests you receive from the insurance company, as failure to do so may result in delays of payment, increasing your level of financial responsibility. If you have questions about what the insurance company needs from you, call them for clarification.
The Medicare and Medicaid replacement plans are showing up more frequently in our area. Before you switch to one of these plans, make sure you are clear on what services are covered, which providers are included and what your financial obligations are going to be.
Being sick or injured is stressful enough. Help yourself understand your health care finances as fully as possible by keeping good records and asking lots of questions.
Adam Hamilton is patient accounts manager for A.O. Fox Memorial Hospital.
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