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Organizing Insurance Paperwork
I would like to have some advice about how to
1) keep track of medical expenses, which are partially covered by our health insurance
2) keep track of EOB received from our health insurance company (United HealthCare).
I would like to know how someone with large medical claims with problems with his or her insurance company to efficiently file and organize all the documents.
The thing is,,, our health insurance company keeps making mistakes with our claims, such as covering only out-of-network lower percentage to in-network facilities/doctors/providers, forgetting to cover 100% even though we have already met our annual maximum out of pocket expenses, forgetting to apply RAP exception to anesthegia doctors'fees even though they have been performed at in-network facility with in-network doctors, etc, etc.
I do return the claim back to have them reconcidered yet they keep making mistakes. As a result, I have started to receive statements from medical facilities and doctors' offices based on incorrect EOB that they received from our insurance company. My husband's benefit department has been helping us minimally, and what is left to me is almost a full time work of calling/filing/sorting/tracking medical bills and EOBs. We have also made more payments than we needed to as a result. I am being patient to deal with everything with our insurance company and they are currently supposed to be going through all of my son's medical claims to correct mistakes, yet they still are sending wrong EOBs even now. It is getting extremely time consuming and stressful.
Have anyone had any issues with your insurance companies' incorrect claim handling, and how did you effectively solve your problems? Does anyone have any good ideas about how to keep both medical bills and insurance company's EOBs so that I can access information more quickly? Any advice is appreciated. I want to spend my precious time for something fun with our family, not for our insurance company's mistakes. Mika
They did mention an instance of a patient hiring a consultant (Lin Osborne) to successfully straighten out billing problems. I did a Google search ''Lin Osborne medical billing'' and landed at this page that might help you:
http://www.billadvocates.com/find/advocate_by_state.htm#California Wading in Medical Bills, Too
This is a confession and cry for help from an organizationally-challenged person. Perhaps someone can say how they deal with this. I can not seem to come up with a good system for dealing with my medical bills and insurance claims. I get a bill, but don't pay it because I'm waiting for my insurance to pay its 80%. But then I sometimes don't keep good track of whether insurance paid it or denied it, until the hospital is sending me to collections. At which point I pay (sometimes the whole thing) to avoid bad credit. Obviously I am a good candidate for a hassle-free HMO, but I like the freedom of my PPO. I am currently putting all my medical bills and insurance statements in one folder, so I can go through them. Is this what others do? Do you have a different folder for different months? Or keep a log of medical expenses? (Why so many bills: 2 of my family members had surgery this year). Thanks for any suggestions!! Befuddled By Bills
Other tips: I take a highlighter and highlight the providers name and the date of service on the claim form. It helps to distinguish it from the other paperwork, otherwise they all start to look alike.
Also, if your insurance company has a contract or relationship with the provider, there is a limit to how much you have to pay. Sometimes you are billed more, so look out for that. After your insurance company pays on something, wait for another bill fromt he doctor and compare it to the claims section ''it's your responsibility to pay $x.00.'' You can make a copy of that and send in your balance, sometimes saving a few bucks. Good luck!! finally have a system
I keep a piece of note paper with each unpaid claim so that when I have to call the insurance company to find out why they still haven't paid the claim, I write the date, time, name of the person(s) I talked to and what they said. If the provider is protesting lack of payment, I call them up and explain that the insurance company is taking its sweet time to pay up. Sometimes the provider made a mistake in the filing, and I go back and forth getting this straightened out. It's a ridiculous hassle.
It's a bad idea to pay the insurance company's portion because then the provider gets paid twice and they take their sweet time to reimburse you. Once a provider tried to get away with not reimbursing me, I think she hoped I would forget.
If the insurance company is taking so long to pay that your account is being sent to collection (try to persuade the provider not to do this), you can be very stern on the phone with the insurance company, try to speak to a supervisor and threaten to contact the California Insurance Commissioner. If that doesn't work, send a letter to the Insurance Commissioner detailing your problem and cc it to the insurance company. The Insurance Commissioner will send you a claim form, but the insurance company always paid up right away before I had to file the claim. It's amazing how well that works. Louise S
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