Managing Medical Bills and Insurance Paperwork: 7 Tips for Maximizing Reimbursement

Do you become frustrated and overwhelmed when managing medical bills and filing health insurance claims? Managing and filing insurance claims can be a complex, frustrating, stressful, confusing and time-consuming process, particularly for families who have children with special needs.  But, given the high cost of health care today, it is critical that claims be filed and managed correctly to ensure you receive all the payments due to you and that you pay only the bills you’re supposed to pay.

Here are some helpful hints on managing medical bills and health insurance claims paperwork from Harvey J. Matoren, MPH, CCAP, who is President/CEO and co-owner/founder of Claims Security of America, a nationwide medical bill management and claims assistance/filing service that helps patients and families manage their medical bills and insurance paperwork.  Matoren’s tips should help get you through the red tape, give you peace of mind and, hopefully, put more money back in your pocket.

  1. Whenever possible, try to have the doctor’s office file your claims and even accept assignment. If your doctor accepts assignment, it means that she agrees to file the claim and to accept, as payment in full, the amount the insurance company approves. Your doctor cannot “balance bill” you for the difference between her charge and the approved amount. In most cases, the insurance company will pay the provider directly when she participates with the insurance program. If the provider accepts assignment or participates with your insurance program, your only obligation usually is the co-payment, as stated in the policy. Many providers will ask for this co-pay at the time of your visit. Try to have them bill you for the co-pay after they have filed the claim and been paid by the insurance company. Many people pay the wrong co-pay. For example, they pay 20 percent of the charged amount instead of 20 percent of the approved amount, and consequently overpay and never get back a refund.
  2. If you have more than one insurance policy, do not assume that the provider will file the claim.If you have to file the claim, be certain to give the insurance company all the information it needs. Incorrect or missing information will only cause a delay in processing the claim. If you need to submit an itemized statement, be certain the following information is included:
  • Diagnosis
  • Description of service
  • Charge for each service
  • Date of each service
  • Location of each service
  • Name of the provider (doctor, hospital) who actually treated you
  • All appropriate insurance numbers
  1. File your claims as soon as possible.Don’t let the bills or receipts pile up — and, certainly, don’t save all your claims until the end of the year. Timely submission of claims is critical in receiving reimbursement.  Even if your provider agrees to file the claim, you should be sure that it is filed within the filing time limits imposed by the insurance company.  Claims filed too late could result in a bill to you from your provider for services that should have been paid by insurance.
  2. Don’t pay any bill unless it is clearly understood that it is a final accounting and you are responsible for it.  Never pay a bill until you have received the explanation of benefits form from your insurance company, which indicates who and how much was paid.  Bills are sent prematurely and many patients pay bills before knowing if the doctor or hospital has received a payment from the insurance company.  Duplicate payments to the provider very often result in refunds that are due to the patient but not returned.  When you do pay a bill, keep records according to the date of payment and check number.  This is necessary if you receive a duplicate bill indicating that payment has not been received, and verification of payment is required.5. Know what’s covered and what isn’t.A lack of knowledge regarding benefits often leads to patients being billed and paying for services that should be reimbursed or written off.  Check your policy to be certain of the covered benefits.

    6. Appeal rejected claims regardless of the reason given. The provider could be helpful, especially if he has not received payment for the service. In addition, appeal all claims that you believe were not paid at the appropriate level.  An insurance company may say that the provider’s charge exceeds the allowed amount (referred to as exceeding the “usual and customary charge”), but this may not be the case.  A Government Accountability Office (GAO) study several years ago indicated that, of the millions of dollars of rejected Medicare claims annually, only about 2 percent are ever appealed.  However, of those 2 percent that are appealed, approximately three-quarters are overturned in favor of the patient.

    7. If you have to file your own claims, make copies of everything you submit. This will make it easier for tracking and follow-up. It will also facilitate resubmitting claims if and when the insurance company tells you it never received the information.

Above all, don’t be intimidated by the system, Matoren says. If you are persistent, aggressive and assertive, you will be able to maximize your reimbursement, minimize your stress and get peace of mind.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

FRAUD ALERT: Equifax Breach

About half (143 Million)  of  American consumers sensitive personal information was exposed in a data breach at Equifax, one of the nation’s three major credit reporting agencies. According to Equifax, the breach lasted about two and a half months, from mid-May through July. The hackers accessed people’s names, Social Security numbers, birth dates, addresses and, in some instances, driver’s license numbers. They also stole credit card numbers for about 209,000 people and dispute documents with personal identifying information for about 182,000 people.

There are steps to take to help protect your information from being misused.

  1. Visit Equifax’s website.
  2. Find out if your information was exposed. Click on the “Potential Impact” tab and enter your last name and the last six digits of your Social Security number. Your Social Security number is sensitive information, so make sure you’re on a secure computer and an encrypted network connection any time you enter it. The site will tell you if you’ve been affected by this breach.
  3. Whether or not your information was exposed, U.S. consumers can get a year of free credit monitoring and other services. The site will give you a date when you can come back to enroll. Write down the date and come back to the site and click “Enroll” on that date. You have until November 21, 2017 to enroll.
  4. You also can access frequently asked questions at the site.

For additional information and other steps that you can take to protect yourself, visit the website for the Federal Trade Commission.

 

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Gift Ideas for Nursing Home Residents

While this is a repeat of a blog from several years ago, it may be a help to some of you as we enter this holiday season. The best gift that you can give to a nursing home resident is a visit. If you cannot visit or want to do something extra for the holidays or their birthday, the following is an adaptation of a list published by the California Advocates for Nursing Home Reform in the winter of 2011.

  • A new pair of slippers or a robe in a favorite color.
  • A gift certificate for a haircut, massage, or manicure.
  • Recent pictures of family and friends in an album, frames, or a bulletin board.
  • Video record a family event that the resident was unable to attend and enjoy watching it with them.
  • A subscription to a favorite magazine or newspaper.
  • Crossword or word search books. (Perhaps in large print.)
  • A personal television for the resident’s room or wireless headphones for their television.
  • A wireless reading device.
  • Quilt or lap blanket.
  • Regular deliveries of flowers.
  • Plant.
  • Tote bag for walker or wheelchair.
  • Luxury toiletries.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Paying Home Health Care Workers

We are frequently asked questions about how to pay home health care workers. Unfortunately, the cash arrangements that many people use to pay caregivers are not legal and we need to discuss the risks and liabilities of this practice.
It can be very confusing for the consumer to distinguish when a home health care worker is a private contractor and when they are an employee. When the worker also lives in the home, there are additional considerations about record keeping and overtime compensation.
There are even some concerns about liability when the home health care worker is hired through an agency of which the consumer needs to be aware. The United States Department of Labor has published a guide to address some of these issues. The following link will direct you to their website to download the guide, “Paying Minimum Wage and Overtime to Home Care Workers: A Guide for Consumers and their Families to the FLSA.
While this publication does not address all of the issues that need to be considered, like insurance and withholdings, it is a good start to understanding how to classify and pay in home health care workers.
* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

SCAM ALERT: Fraudulent Family Calls

Have you ever gotten an emergency phone call from someone pretending to be a friend or family member? The caller may claim that they are in jail, in the hospital, have been robbed, or being held hostage. The things that all of these calls have in common is that they are going to ask for money and they are fraudulent. If you get one of these calls, you should follow these guidelines:
1. Do not give the caller any personal information.
2. Hang up and check it out. Contact your family member or friend directly.
3. Never send money to anyone who calls and asks you for it.
4. Go to consumer.FTC.gov and report it.

The Federal Trade Commission has published a short video with more information. Click here to view.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Today is World Elder Abuse Awareness Day

I have had phone calls the past three mornings (including one at 5:00 a.m.) from a recorded caller claiming to be from the IRS and demanding that I call them back immediately or the IRS will file a lawsuit against me. I have not returned these calls, however there is a good chance that someone that I know or that you know may be frightened by a call such as this and will respond to the call. I am sure that the first thing that they will be asked for is their social security number and maybe even their bank account number to transfer funds to settle the lawsuit.
This is just one of the many scams that are taking place every day. The purpose of having a world elder abuse day is to educate older adults and those who care for them about the many types of financial elder abuse that are occurring and how to prevent them. While it is not always easy to identify financial elder abuse, you can watch for changes in the older person’s financial activities that may signal that there is an issue, such as:
• Unusual changes in wills or powers of attorney – Out of the blue, your grandfather wills all of his belongings to his new caregiver.
• Financial activity the person couldn’t have done herself – You discover repeated online credit card charges on your mom’s bill, who does not know how to use a computer.
• Bills not being paid – When visiting a neighbor, you see mail piling up on his desk or you stop seeing his lights on at night.
• Significant withdrawals or unusual purchases – You notice charges for luxury items on your thrifty aunt’s credit card bill.
The following are some additional online resources that I recommend:
The Federal Trade Commission (FTC) “Pass it On” campaign has a number of resources for the consumer to protect themselves and others from scams.
The Consumer Financial Protection Bureau (CFPB) has tools for caregivers that are trying to assist older persons with their finances. You can download their publication “Money Smart for Older Adults.”
* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Estate Administration Video

Leslie Yarnes Sugai and Sheri Sudweeks were recently interviewed for a local real estate television program, Kapowich on Real Estate. In this episode, which is the second of a two part series, they discuss estate administration issues.
Topics covered include:
Discussion of what constitutes an estate administration, trust administration and probate. How long you should expect these processes to take and how they affect the sale of real estate.
The on-going administration of Special Needs trusts and how they are administered to bring additional benefits to persons with disabilities for their lifetimes. The ownership of real property by a special needs trust.
Discussion of Guardians of the person and estate of minor children and the limitations of the control of the assets when a trust is not utilized.
Understanding the term Private Professional Fiduciary and the role that they can play in the administration of an estate by court appointment in a contested matter or by the election of the person who creates the estate plan.
To view the program, click here.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Estate Planning Video

Leslie Yarnes Sugai and Sheri Sudweeks were recently interviewed for a local real estate television program, Kapowich on Real Estate. In this episode, which is the first of a two part series, they discuss estate and incapacity planning issues.
Topics covered include:
The documents that constitute an estate plan. Trusts, Wills, Advance Health Care Directives, and Powers of Attorneys. How estate planning affects the title to real estate.
Special Needs planning for persons with disabilities to enhance the lives and health of those who are dependent on public benefits.
The facts and myths behind Medi-Cal and Long Term Care Planning. Understanding what is meant by the home being an exempt asset, how the home is valued and recovery issues.
The difference between amending a trust and modifying a trust. In California the law allows for the modification of trusts by the Court, even those that are irrevocable under certain circumstances.

To view the program, click here.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Are You Ready?

The State of California has developed a non-profit website to help consumers navigate the overwhelming and costly issue of long-term care. They offer planning tools, brochures, calculations, and information on long term care insurance policies. As two out of three Californians are projected to need long-term care this information can help you make sure that you have prepared for the needs of yourself and your loved ones.

* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.

Tax Identity Awareness Week

As Tax season approaches make sure that you do not fall victim to the fraud and scams that abound. Listed below are some of the events that are being hosted by the Federal Trade Commission and its partners on how to minimize your risk what to do if your identity is compromised.

 
• January 26, 2 p.m. – an FTC webinar for consumers, co-hosted AARP’s Fraud Watch Network and Tax Aide Program. Learn how tax identity theft happens and what you can do if it happens to you.

 
• January 27, 11 a.m. – the FTC and the Department of Veterans Affairs (VA) will host a Twitter chat with information about tax identity theft for veterans. Join the conversation at #VeteranIDTheft.

 
• January 27, 2 p.m. – the FTC, TIGTA and the VA will host a webinar with information about tax identity theft for veterans.

 
• January 28, 1 p.m. – the FTC and the IRS will co-host a webinar with information to help victims of tax identity theft.

 
• January 29, 2 p.m. – the FTC and the Identity Theft Resource Center will co-host a Twitter chat about tax ID theft. Join the conversation at #IDTheftChat.

 
For more information on each of these events go to the Federal Trade Commission website. You can also visit www.IdentityTheft.gov, the government’s one-stop resource to help identity theft victims recover.

 
* The information contained in this Blog is intended for general information and educational purposes only and does not constitute legal advice or an opinion of counsel.