At some point almost everyone has a medical bill that, for whatever reason, hasn’t been paid. The fault isn’t always that of the people in the billing office; as a matter of fact, if it’s not paid up front it’s rarely their fault. However, if a claim hasn’t been paid for a long time then it’s possible that it’s their fault and based on negligent or something they don’t know to even check.

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Therefore, even though it’s not supposed to be your job to handle it, there are 4 ways to get them to look at your hospital bill to see if maybe there’s something they’ve missed, or someone else has missed, that’s keeping your claim from being paid. Let’s look at 4 of these things.

1. Verify your insurance information. Sometimes it’s a very simple thing, maybe a misplaced number or a misspelling of a name. It could even be a bad birth date, or having the claim sent to the wrong office, which happens with some of the larger insurance companies that have multiple locations from where they pay bills.

2. Ask them if the diagnosis code fit the procedure codes. They may not know this up front but you have the right to ask them to look into it. What sometimes happens is that the diagnosis that was coded by medical records doesn’t match up with what’s being billed for, which often means someone captured the wrong procedures. I’ve seen multiple bills with things such as mammograms showing up on the bill of a male patient. Charge capture can sometimes be dicey.

3. Ask them to tell you what the denial reasons are that they’ve been getting from the insurance companies. If it’s a billing office worth anything they’ll be able to tell you this, but it’s possible that they might not post it electronically. What you’re trying to discover is whether they keep getting the same denial or if there are different issues that come up each time. By the way, your insurance company should have sent you something every time there’s a problem with getting a claim paid as well, so you might end up having to call them.

4. If you’re covered by more than one insurance company, ask them if they’re sure they billed the correct one first. There are many issues with the concept of “coordination of benefits”, which means deciding who should be billed first. In some states there’s what’s known as the “birthday rule” which states that when billing for a child whichever parent’s birthday comes first in a calendar year is the primary insurance. For older workers, it’s possible that Medicare may not be the primary insurance if they’re working full time, or if their spouse is still working full time and they’re covered under that insurance.
 

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