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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Don't
pay a bill you don't understand
July 30, 2004
Q:
I
have had a lot of medical bills recently. I have three
insurance carriers. After all payments are made by my
insurance companies to my doctors, quite often the medical
office will try to bill me for the remainder. My copy
of the explanation of benefits shows I am responsible
for "$0." When I call my insurance, they tell
me the medical office is attempting to "balance
bill" me. Federal law prohibits them from doing
this. Upon telling the medical office this, they always
agree to write it off.
I
know a lot of people pay these extra amounts without
knowing they don't need to. Could you say something
in your column about this to warn them?
A:
Yes,
I can definitely say something about this. I have said
it in past columns, and I will say it now, and I will
say it in future columns. The whole purpose of my column
is to make people better health care consumers when
it comes to their medical bills. And the single most
important issue is not to pay a bill you don't understand.
Don't assume the bill you receive from your health care
provider is correct if it doesn't make sense to you.
You are entitled to an explanation and to understand
that bill.
The
explanation of benefits that you receive from your insurance
company will tell you what you owe or what your responsibility
is. This amount must match any bill you receive from
your health care provider. If the amounts do not match,
there is an error.
When
doctors are providers of your insurance company they
sign a contract agreeing to specific payments for each
procedure they perform. Anything billed over this amount
is written off. The doctor accepts what the insurance
company allows as their full payment. For example, if
the doctor bills $100 for an office visit and the insurance
company only allows $75 for that visit, the remaining
$25 is written off. The patient does not pay this disallowed
amount. The insurance payment is now based on a $75
claim. Co-pays and deductibles are now based on this
$75 allowable charge.
Always
make sure you are not being charged for the insurance
write off. It makes no difference if the office is attempting
to "balance bill" or if the insurance clerk
at the doctor's office does not know how to read or
post insurance payments properly, only pay the amount
you are responsible for.
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