The team at Escaping the Healthcare Prison is dedicated to showing how healthcare consumers can escape their PRISON. Each of us has been a healthcare prisoner one time or another. The spectrum of issues is endless. Our monthly ESCAPE PLANS will help you navigate the healthcare maze.
BACK ROUND:
A 19-Year-old college student (we will call her Sally) became ill while away from home. She went to the emergency room and they determined she needed an Appendectomy. Sally was admitted to the hospital and the surgery was performed. The surgery was successful, and Sally was discharged. Sally had insurance with a large deductible.
SIX TO EIGHT MONTHS LATER:
The bills started to roll in; from the hospital, numerous doctors, etc. Sally’s mom was overwhelmed and asked the team at Escaping the Healthcare Prison to review the bills. The team received a copy of all the bills along with the Explanation of Benefits (EBO’s) from their insurance copy.
THE BILLING AND EOB REVIEW:
The team started to match the bills to the EOB’s. This step is critical because all the claim processing transactions on the EOB should be the same as they are on the bills. In Sally’s case, all EOB’s matched up with bills with the exception of one, the Hospital bill. There was one missing transaction on the EOB that did not appear on the bill, an $850 adjustment. The adjustment was the difference between what the insurance agreed to pay versus the hospital retail charges. The hospital should have adjusted the bill by that amount. The team secured a release from Sally and called the hospital. The hospital was surprised, and customer service representative said they needed to talk with their supervisor and would call us back. Several days later we received a called from the hospital apologizing for the error and adjusted the bill for the $850. Sally was incredibly grateful.
TAKE AWAY REGARDING MEDICAL BILLING:
- Always match you EOB’s with the bills received from your hospital, doctor, etc… Never assume the bills are correct. Studies have shown that 8% of the bill’s consumers receive are wrong.
- If you detect a difference between your EOB and bill, call the healthcare provider and ask them why. Be professional but demanding…they owe you an explanation.
Your team at Escaping the Healthcare Prison is always there to help the consumer. Use our website to let us know how we can help.
www.escapingthehealthcareprison.org
