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Retrofit Door Sill Ramp
Medical Bills
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Free or Discounted Prescription Programs
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Legal Adults - Introduction
Guardianship and Declaration of Incapacitation
Establishing Guardianship and Obtaining a Declaration of Incapacitation
Dependency Determination (Military)
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Exploring Possibilities and Guardianship Issues - Age 17
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Introduction: Special Needs and the Military Family
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TriCare Extended Care Health Option (ECHO)
Early Intervention
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Van Conversion: A good Example
Fund Raising - The Flamingo Air Project
Utah DSPD Complaint List Winter 2011

Medical Bills

Every time you sign billing consent forms at your doctor's office or local treatment facilities you are agreeing to be responsible for those specific charges that are incurred during that visit. Therefore, you will need to make sure that all charges are paid whether by yourself or your insurance company. The ultimate responsibility for all bills rests with you.

Taking Care of Your Medical Bills

There are several ways medical bills can be handled but it is the responsibility of the patient (or the patient's parents/Guardians) to follow up on every single one of them. Some bills may only require the simple process of matching the EOB to the provider's statement. Others may require more in depth follow through. Maintaining constant contact with creditors, especially medical billing sources, is very important. By ensuring that bills are taken care of correctly you will save money for both yourself and your insurance company. Every bill needs to be dealt with. It does not matter if you have a comprehensive insurance plan, or no insurance coverage at all, every medical bill must be followed through until paid in full.

We recommend the following steps to help keep your medical (and household) bills in order.

Keep and match your EOB's and billing statements.

Each EOB needs to be read and double checked for accuracy to make sure bills are paid correctly. When you receive a billing statement from a provider or a creditor, it needs to be double-checked against the matching EOB you receive later to make sure that they are correct and there are no discrepancies. Staple matching EOB's and billing statements together. File them by date in the appropriate file (See Getting Started: Organizing Your Information). You will need to maintain a file for each creditor and follow those bills closely. It is the parent's responsibility to ensure that bills get paid correctly.

It is important to know these statements can be proof of payment, will assist you in keeping track of the amounts coming out of your own pocket, and allow you to ensure that payments are being made properly. At the end of the calendar year your medical statements will need to be consolidated into a single file and kept with your tax returns. (see Medical Bills and Income Taxes for further instructions)

What to do if you find an error on your billing.

The first thing to do is gather your statements, the matching EOB, your insurance information, a Call Form and a pencil. Find a comfortable spot for taking notes and call the billing office. It is the parent's responsibility to call the creditor or the insurance company to make sure that whatever error has occurred is brought to their attention. It is important to verify billing charges or payment amounts and request an explanation for anything you do not understand. Go line by line if you have to. Don't be afraid to ask why an item was charged for or if the amount charged, paid, or not paid, is correct and fair. Just remember to be polite.

When calling any company about billing errors it is important to document your conversations. If the back side of the bill is blank use it to make your notes. Turn it over, put the name of the individual, their title, phone number, the date and time the phone call was made, and what was discussed on the back of that billing. (You may find using the Call Form helpful for bills with other information on the back. Be sure to staple it to the statement). Keep notes of what is said and any agreements you may make.

Several times, Linda has had to fax that information in to providers or insurance companies for use as a reminder of what was agreed upon over the phone.

Linda has also experienced a significant billing error, which could have resulted in fraud charges.

The family's Home Health Provider had mass-billed eight months worth of skilled nursing services and disposable medical equipment charges all at once but had not provided the required documentation to the primary insurance company. This resulted in a denial of payment for those services by the primary insurer. Rather than check the billing for errors themselves and sending the required documentation as requested, the Home Health provider assumed the denial was appropriate and billed the secondary insurance company, Medicaid, who paid in full.

Upon receiving eight months of EOB's from the primary insurance company marked, "Denied - Further documentation requested but not received from service provider." Linda became alarmed and compared the billings from the provider. Closer review showed payment by the secondary insurance company but no payment from the primary (or first) provider. Linda spotted the error. The Home Health provider had not followed through in sending the requested documentation proving medical necessity and had billed Medicaid instead. Linda contacted the primary insurance company and they stated that they had requested letters of medical necessity and nursing notes from the provider but the documents were never received. The bills would be paid provided the documents were received from the Home Health provider.

Once it became clear what the problem was Linda contacted the Home Health provider billing office directly and requested to speak with the manager. An in depth review of the situation showed the provider company had failed to appropriately follow through with the billing process. This resulted in $70K worth of bills being sent through Medicaid, which should have been paid for by the primary insurance company, had they received the proper documentation when they requested it.

While all of this was going on, the Home Health provider finally recognized their error and sent the requested documentation to the primary insurance company. Full payment was made to the Home Health provider that resulted in the provider being paid twice for the original billing. First by Medicaid, then by the primary insurance carrier. The Home Health Company made no attempt to notify Medicaid of the double payment. Without quick action this would have been considered Medicaid fraud.

Once Linda began receiving EOB's showing payment made by the primary insurance company for the previously denied services, she alerted her local Medicaid case manager of the payments and faxed copies of the EOB's showing the payments. The State Medicaid office was then able to initiate a recapture of funds from the Home Health Agency, which resulted in a complete audit of the family service billing records. This created a total billing snarl that delayed payment for services for the next 12 months while the family account was audited.

When the account audit was completed it was determined the primary insurance company DID pay for services rendered, which were covered, Medicaid had been billed and also paid the full amount billed to the Home Health provider resulting in a large double payment. The Home Health Provider had to repay Medicaid the total amount billed and were then subjected to a company wide audit. (Needless to say, Linda no longer uses this provider for services...of any kind). Ultimate responsibility for the payment of charges incurred rested with the billing company but it was also Linda's responsibility to ensure that proper payment had been made as the bills were incurred by her family member. Prompt reporting of the problem to all parties involved prevented fraud charges from being filed

*Note: When in doubt or unable to reach an agreement, ask for the office supervisor. It is important to stick with your problem until it is resolved to the satisfaction of all parties involved. If you are unable to reach an agreement, believe you have been treated unfairly or the process has been completed in error it is time for an appeal.