A GUIDE TO MANAGE YOUR PATIENT BALANCE OR MEDICAL BAD DEBT
Healthcare Consumer Navigator Center is committed to helping the consumer reduce your patient balance or medical bad debt. This guide is designed to be a step-by-step process. Each step is supported with additional information on our web site.
Our web site is www.healthcareconsumernavigatorcenter.com
The guide below will have multiple steps. Most steps will have a Document Reference Number. On the website Home Page, select Consumer Information Navigator and locate Section 1. Each step will have one or more reference numbers referenced in the step-by-step process. This is supplemental information. In addition, Section 1 can be accessed by the link on the Step-by-Step process.
Their maybe situations when you will be unable to resolve the balance. If that occurs, go to our web site select Contact Us, Share Your Story and complete the form. Our team will contact you to determine the next steps
The following is the self-guided process:
STEP 1 Critical Healthcare Terms You Need to Know
Understanding basic terms will help you communicate to the any provider. Reference Document 2
STEP 2 Know Your Explanation of Benefits (EOB): Reference Document 3
How to Read and Understand Billing Statements: Reference Document 4
These two healthcare documents are important for the healthcare consumer to understand and maintain. These documents show how your bill was paid.
Locate Your Summary of Benefits and Coverage and Your Approved Healthcare Provider List
The Accountable Care Act requires your insurance company to provide you with this document. Have it available when you start the verification process. In addition, have available your approved Healthcare Provider List. These are baseline documents to reference when verifying your bills. Reference Document 8
STEP 3 Verify the patient balance you owe is correct.
This is the first critical step.
- Locate your Insurance EOB that matches your service date on your Billing Statement.
- Make sure the patient balance on your Bulling Statement you owe matches the EOB. The billed charges, contractual adjustments and payment must match the EOB.
- If yes, you owe the amount; If no, your balance maybe wrong. Call the healthcare provider and explain to them what you found. Let them explain why it does not match. Reference Document 5
- If you do not have insurance and your patient balance is billed charges, you may be eligible for a discount. Call the healthcare provider and explain to them what you found. Ask them for a discount. They should offer you at least a 40% discount if not more. The rationale for the discount relates to what insurance companies pay.
- The No Surprise Act applies for services provided after January 1, 2022. The critical part affecting consumers is whether your service was in or out of your insurance company’s provider network. If you were treated by a healthcare provider NOT in your provider network, you maybe are eligible under the act. This means your insurance MUST pay in network rates. Call you healthcare provider if the EOB does not reflect the adjusted payments. Reference Document 9
- The purpose of the notice and consent form is to let you know about your protections from unexpected medical bills. It also asks whether you would like to give up those protections and pay more for out-of-network care. IMPORTANT: You ARE NOT required to sign this form and shouldn’t sign it if you didn’t have a choice of health care provider when you received care. You can choose to get care from a provider or facility in your health plan’s network, which may cost you less. If you’d like assistance with this document, ask your provider or a patient advocate. Take a picture and/or keep a copy of this form for your records. Reference Document 10
Step 4 How to Negotiate a Medical Bill: With a Provider or in a Collection Agency
Reference Documents 6 and 7 help you navigate this process. These documents will provide you with options and suggestions when communicating with the healthcare provider or collection agencies.
Step 5 If all Fails, Contact Us
The link below directs you to Section 1 with all the referenced documents listed.
Consumer Information Navigator