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Know the Laws, Rules... and keep documents of everything

Discussion in 'The OT' started by Earl Bonovich, Jul 17, 2007.

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  1. Earl Bonovich

    Earl Bonovich Lifetime Achiever

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    Last year, I had a medical emergency....

    Late last year, the insurance company finished their "research" and paid the claims according to the rules of the plan.

    One Dr... decided they did not want to honor the negotiated contracted amount... So they waited till after the 6 months period, (180 days), and then balanced billed me.

    (Which is against the Law here in Illinois, and pretty sure everywhere else).

    So back in March, I had to deal with his billing department... sent the EOB, statements, and a brakedown showing that I didn't owe them anything.
    I thought everything was resolved, and have not had any further communication since confirming the receipt of the documents and that everything was in order......

    Untill today, and get a nice automated message from a collection agency.
    (Which I probably would have blown off, if the message wasn't cut-off.... as I am the administrator of my father's estate, and getting these messages are not out of the ordinary... but anyway)...

    Called them back, and found out it was for this issue, which I thought was resolved back in March (which at that time I thought was resolved back in September).

    I still had my documents here in my folder (with my Dad's items).
    So I was able to explain to the collection agent (that wanted to setup a payment plan)... she asked for the docs... so we will see where it goes from there.
    ............

    Moral of the story.

    Even though EOB's are a pain to read.... read them, understand what they mean... and lastly NEVER throw them away. Save them with your medical bills for that event.

    EOB's are the #1 most usefull document you can have with medical claims.
    I spent 5+ years working for a HealthCare Insurance agency (United HealthCare), and learned IMMENSE amounts about the rules and regulations of medical claims.

    EOB's are almost as good as money in some cases.

    And with more and more companies going electronic for their EOB's..
    Print them out (either to paper, or to a stored PDF file), and store them.

    [/off soapbox]
     
  2. Stewart Vernon

    Stewart Vernon Roving Reporter Staff Member Super Moderator DBSTalk Club

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    I went through a surgery years ago... and at first I was getting double-billed. Hospital and Dr was sending to me AND my insurance... I waited for the Insurance company to reply to everything... then waited a little longer... then paid what amounted to my deductable since I had gone way past that... and fortunately in my case that was the end of it.

    I did save everything for a long while after that (I may still have it somewhere) because like you, I was sure if I threw it away then 6 months later they would try and bill me again.
     
  3. Earl Bonovich

    Earl Bonovich Lifetime Achiever

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    Even if you don't want to keep the originals...
    Highly worth the $100 or so bucks for a scanner, and generate PDFs out of them, so you can save them digitally "forever"
     
  4. paulman182

    paulman182 Hall Of Fame

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    Earl, good advice.

    In your particular case, however, I'll bet the collection agency continues its efforts anyway.
     
  5. Earl Bonovich

    Earl Bonovich Lifetime Achiever

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    We will see... they where extremely receptive to the fact I called them back in 2 minutes, and then called again to confirm the receipt of the fax.
     
  6. personman

    personman Legend

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    Apr 24, 2007
    I do have a cheap scanner, what settings do you recommend for archiving things like this. Bitrate, color, ect.
     
  7. Earl Bonovich

    Earl Bonovich Lifetime Achiever

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    Color would be better... just to have more of an exact replica...
    BitRate... 300dpi should be MORE then enough...

    Then you can use a program like CutePDF to "print" to a PDF file...
    And that should be more then enough for archiving purposes.

    I would still keep the paper versions for at least a year, for documents like that...
    But at least the PDF will give you quick access, before you have to go up to the attic to get originals
     
  8. DonLandis

    DonLandis Hall Of Fame

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    Earl, you are good to advise everyone of your experience. This year we have UHC and when I had some need for it in January, the plan paid everything after my wife got involved. She is an insurance consultant for large groups and knows what to look for. We had about $6k of fraudulent billing from doctors and medical service organizations. The only problem with UHC was their refusal to pay first charge on the ambulance which was triple billed anyway. Wife told them that ambulance charges don't have to in network because it is out of the persons control at that time. They backed off and paid it-- Once!
    In my research on the frequency of doctors multiple billing was that it is pervasive in the industry. Some doctors, who have been discovered making it a regular business practice, were brought to trial and stripped of their license to practice medicine.
    With that all said, your advice is well taken and while I know my wife is on top of this I will pass along your experience and be ready for the collection agencies at the end of the year. :(

    The good news is that after $22K of tests, they couldn't find anything wrong with me other than I was suffering from lack of sleep and proper nurishment.. I did get the executive physical and a 1" stack of medical records giving me a clean bill of heath .
     
  9. djlong

    djlong Hall Of Fame

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    Speaking of scanners, does anyone know where I can find a scanner that has a small automatic feeder? I have THOUSANDS of pictures to scan and putting them one-at-a-time onto my flatbed scanner will take a geological amount of time. I'm looking for something where I can dump 50-100 pictures into a hopper, press a button and come back later when the scans are all done.
     
  10. Mark Holtz

    Mark Holtz Day Sleeper DBSTalk Club

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  11. dmspen

    dmspen Hall Of Fame DBSTalk Club

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    Regarding collection agencies...
    You have the legal right to NOT deal with them. Tell them you want to deal directly with the company involved, then write a letter to them to that effect. Also send the letter to the accounting department of the company who's trying to collect.
     
  12. paulman182

    paulman182 Hall Of Fame

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    Is this really true? I know that in many cases, the collection agency has bought the debt and the original company has written it off.
     
  13. EVAC41

    EVAC41 Legend

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    You are exactly right!!!! Keep everything and read everything. Same thing happend to me when my left lung collapised just right out of the blue one night back in 2000. Spent 2 weeks in the hospital and had three different chest tubes put in. It's good to keep all insurance forms and doctors records.
     
  14. dbconsultant

    dbconsultant Hall Of Fame

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    We had gone to a new dentist that recommended some oral surgery for my husband. He didn't trust the new dentist and went back to our original dentist and the original dentist said he didn't need surgery after all. So the surgery was never done. Several months later, we get an EOB for the surgery having been performed when we had never gone back to the new dentist. This maxed out our coverage for the year so we couldn't have anything else done until the issue was resolved! The new dentist wouldn't resolve the problem with us so we called our insurance company and reported the new dentist for fraud. That was the only way to get it taken off of our insurance records.

    Another time we got an EOB for a doctor's visit for my husband and it was called a "well-baby checkup" - he's 61!

    You really need to pay attention to all paperwork you get related to health coverage - I can't tell you how many times we have had to get itemized statements from doctor's offices because their billings and insurance payments don't match the EOB!
     
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