Brian Gruss Licensed Insurance Planner

Four Solutions to Medical Bill Problems

There’s just something a little scary about receiving a medical bill or a letter from your insurance company claiming you owe money. These tiny sheets of paper have the power to send many of us into full-on panic mode.

As soon as you receive a medical bill or explanation of benefits (EOB) from your insurance provider, do you immediately whip out your checkbook and mail in your payment? Are you terrified you’ll be turned over to a collection agency if you don’t pay the bill right away?

Not so fast! Before you cough up the cash for that medical bill or EOB, it’s important to do a little homework. Don’t simply assume that you have to pay the bill. First of all, it could be a mistake. Secondly, the doctor’s office or hospital will not send your bill to collections right away. And most importantly, if you pay the bill only to realize later that it was covered by your insurance, it can be extremely difficult to get a refund.

So, put away that checkbook and read on to learn the solutions to four common medical bill problems:

Common Problem #1:  You receive a bill for a covered service.

Let’s your medical provider sends you a bill for a service or procedure that your insurance has always covered in the past. Don’t assume your insurance provider has simply changed their coverage. More often than not, this just means that the insurance company hasn’t had a chance to pay the bill.

If you receive a bill for commonly covered service, let it sit for 30 days. This should give your insurance provider plenty of time to pay off the bill. However, if you receive another bill from the medical provider, give your insurance company a call to find out what’s going on. You should also call the medical provider to let them know that you’re working with the insurance company to make sure they pay.

Common Problem #2: You see the word “DENIED.”

You go to the doctor or dentist for a standard service that’s usually covered by your insurance company. However, a few weeks later, you receive a claim stamped with the menacing word, “DENIED” in bright red letters.

Don’t freak out because it’s probably just a mistake. The medical provider may have incorrectly coded the treatment. Call your insurance company and make sure the claim matches the actually service you received. If not, let them know what happened, and find out the proper code for your treatment. You may need to follow up with the medical provider, as well.

Common Problem #3: You have a jumbled pile of EOBs and bills and no idea what you owe.

If you have a whole mess of EOBs and medical bills, it can be difficult to figure out what goes with what and how much you need to pay. That’s why it’s important to keep all of your medical records as organized as possible. A little bit of organization could save you a whole lot of time, money and frustration down the road.

When you receive a bill from your medical provider, staple it to the coordinating EOB from your insurance company. Keep all of your bills in a folder so you can easily and quickly access them. If you call your insurance company or medical provider to discuss a particular claim, write notes on the EOB or bill to keep track of who you talked to and what you discussed.

Common Problem #4: Only a portion of your claim was paid.

Let’s say you received a standard medical treatment that’s typically covered in full by your insurer. But a few weeks later, you discover your insurance company covered only a portion of the claim. It could be a slip-up on the insurer’s end or the medical provider could have coded the treatment incorrectly. But more often than not, this happens when you go to an out-of-network provider.

If that’s the case, you’ll probably have to pay this claim. When you go to a provider that is not part of your insurer’s network, you often have to pay more out of pocket. However, if you receive this kind of bill and you’re certain you saw a network provider, give your insurance company a call. It could simply be a mistake.

Of course, this is just a handful of medical billing problems. Patients deal with these and countless other medical billing issues day in and day out. So, the next time you receive a bill or EOB in the mail, don’t panic. When in doubt, call your insurance company and/or the medical provider to discuss your concerns.

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Expatriate Insurance: Playing Safe While Living Abroad

You have the opportunity of a lifetime to live abroad for the next year.  You’ve planned every part of your stay down to the last detail – or so you think.  Have you thought about what will happen if you become so ill that you require extended medical treatment?  Even if you live in the most cosmopolitan of cities, if you become critically ill you will want to return home to be near family and friends while you recover.

You may believe if that scenario arises, you can depend on your managed care plan.  However, your stateside health insurance plan is not designed to cover extended stays out of the country.  Health Maintenance Organizations (HMOs) cover emergency room treatment anywhere, but typically offer other coverage through provider networks in the state where you live.  Preferred Provider Organizations (PPOs) cover a larger percentage of medical expenses if you visit network doctors, which are usually local.  Medicare offers no coverage at all for medical expenses incurred while living outside the United States.

What about travel insurance?  Your instinct tells you this is where you will find the coverage you need.  It seems logical, but it isn’t quite correct.  Travel insurance usually offers coverage for a period of six months.  Should you become sick or injured during the benefit period, your treatment is only covered until you reach the end of the six months.  After that point, you would be responsible for your own medical expenses.

So what alternative do you have to make sure this trip doesn’t end up costing you far more than expected because of unanticipated medical bills?  You can purchase expatriate health insurance.  The name tells you exactly what the coverage offers.  It is derived from the Latin language in which “ex” means away from, and “patria” means Fatherland.  This insurance is especially developed for people who will be away from their home country for six months or more.  Expatriate health coverage is designed to overcome the problems with the geographic limitations and restrictive provider networks that are associated with your managed care plan.  It also helps a sick or injured expatriate deal with language translation, currency exchange, and transportation to Western treatment centers when trying to navigate through the maze of a foreign health care system.

There are two types of plans. The basic plan offers coverage for in-patient or in-hospital care including your actual hospital stay, various medical service providers and transportation by local ambulance. You can purchase enhanced basic plans that may also include outpatient visits, some therapies as well as prescribed drugs. At-home nursing care and emergency dentistry are also covered typically.

If you require more extensive coverage, comprehensive plans can be obtained for much higher premiums. Comprehensive plans may cover psychiatry, rehabilitation, home nursing, childbirth, eye and ear specialists, dietitians, psychotherapists, chiropractors and osteopaths. Diagnostic tests and prescription drugs may also be covered.

Emergency medical evacuation coverage is available in a number of the basic plans. However, almost all plans allow you to include it for an additional charge. This coverage provides for immediate transportation from anywhere in the world to the nearest medically advanced treatment center for in-patient emergency conditions. Generally such plans also allow for reasonable return fare to your country of residence.

All these health plans have some restrictions and exclusions. If you are employed in a hazardous occupation some plans will not cover you. Pre-existing conditions, either known or unknown at the time you apply for coverage, are usually not covered. Depending on the condition, however, some carriers may be willing to underwrite it for an added charge. Injuries resulting from war or riot are not covered. Some plans do cover acts of passive war and terrorism such as an injury that occurred while you were an innocent bystander.

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Traveling Overseas? Don’t Forget Your Health!

As you prepare for your next overseas trip, whether it’s a vacation in France, China or Bermuda, you’re probably dreaming of delicious local cuisine, incredible sight-seeing adventures or plenty of relaxing days on the beach. But one thing you may have neglected to plan for is your health.

Many international travelers who fall ill while overseas aren’t sure where to turn. If you don’t plan ahead for such an unfortunate event, you could find yourself in quite a bind. Here are a few healthy travel tips you should keep in mind as you plan your next overseas journey:

Pay your doctor a visit. Before you board an international flight or step foot on a cruise ship, set up an appointment with your physician—especially if you have a medical condition. Your doctor can give you a thorough checkup to make sure you’re healthy enough to travel overseas.

Research the health care system of your final destination. Although quite a few international destinations, such as China, Costa Rica and Thailand, offer top-notch medical care, many countries do not. Do your homework and find out if and how you’ll be able to get medical care if necessary. If the country you’re planning to visit has a notoriously substandard health care system, you may want to choose a different destination.

Get familiar with local diseases. If you are traveling to a particularly exotic country, you should familiarize yourself with common diseases and medical conditions in that area. Check with the Centers for Disease Control and Prevention to find out what diseases are common in certain countries. (Visit www.cdc.gov/travel.) For a list of countries that require vaccinations, visit The World Health Organization’s website at www.who.int/ith.

Take a close look at your health insurance policy. Many health insurance polices do not cover you if you’re traveling overseas. For example, Medicare does not cover international travel health expenses. However, certain Medigap policies do. This is why it’s extremely important to read the fine print on your health insurance travel before you embark on that next trip.

If your health insurance doesn’t cover you for trips abroad, you should purchase comprehensive travel insurance. Before signing on the dotted line, make sure this travel insurance policy covers medical evacuations—these emergency evacs could cost you up to $50,000 out of pocket. You should also check the policy for any exclusions—some travel insurance won’t cover injuries that result from “risky” activities, such as mountain climbing or scuba diving.

Pack your meds. Don’t forget to pack any prescriptions and over-the-counter drugs you may need during your trip. If you have crucial prescriptions, be sure to pack some extra in your carry-on bag in case your luggage gets lost. Bring these meds in their original bottles including the labels. That way, you’ll have the necessary info if you need to refill a prescription during your trip. You should also know the generic names of your medication in case the pharmacy doesn’t carry the brand name.

Don’t push it. Many international travelers try to cram too much into one trip, which can be incredibly stressful on the body. Try to plan your trip so that you’re not rushing to a different city every day. Additionally, if you tire or get winded easily, you may want to avoid trips that require excessive walking or vacations in high altitudes.

Know where to turn if you fall ill. If you do get sick during your trip, you can obtain a list of local English-speaking doctors from the U.S. embassy or consulate. Before you leave for your trip, you may want to request a list of English-speaking doctors worldwide. You can obtain this free guide from the nonprofit organization, International Association for Medical Assistance to Travellers. Visit their website at www.iamat.org or call 716-754-4883.

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