Tracking Medical Bills: 11 Questions to Ask
Author: Sibyl Day

You will receive an incredible amount of mail relating to
your medical care, especially if you have been
hospitalized. If you understand the three types of mail
you will receive for each service, and you know how to
track each bill, you will know exactly when to pay your
balance—not too much, and not too soon.

1. How should I file the statements, invoices, and
explanations of benefits forms?

It is important that you open up every single envelope,
because you could end up throwing away a reimbursement
check! You can sort the documents you will receive in
three ways:

(i) By medical provider (for example, doctor's name,
hospital name, or lab name);

(ii) By date of the first medical procedure or service on
the document (since many documents itemize services from
several dates grouped together on the same form); or

(iii) By type of document (for example, all invoices from
medical providers, all explanations of benefits forms from
your first insurance company, all explanations of benefits
forms from your second insurance company).

Any of these systems will work. What is important is to be
consistent in the filing method you use and to keep it
constantly up to date. If you keep track of your medical
bills as they arrive, you will know when it is time to pay
and how much to pay.

2. What documents will I receive if I have medical
insurance?

If you have a private insurance plan (Blue Cross, Blue
Shield, etc.), or if you have Medicare with a supplemental
insurance plan, there are three types of documents you will
probably receive. They are:

(i) The initial statement or invoice (this may or may not
be sent out);

(ii) The Explanation of Benefits; and

(iii) The final bill.

3. What does it mean when the document says, "This is not
a bill"?

The first document you may receive in the mail is an
initial statement or invoice from your medical provider.
Not all offices generate and send this form. But, if your
doctor or hospital does, this invoice will usually say
"This is not a bill," and it itemizes all of the services
you received.

Unless you are a "private pay" patient who is responsible
for all of your medical bills, you will probably not have
to pay that entire total you see at the bottom of the bill.
This form is simply telling you how much is being billed
to your insurance company.

4. What is an "EOB"?

After the claim is processed, you will receive a second
type of document called an Explanation of Benefits (EOB).
If your primary insurance company is Medicare, you will
receive a form entitled "Medicare Summary Notice" that
itemizes which services they have processed. Medicare or
the insurance company will either authorize payment or deny
it; this statement will tell you how much of the bill was
approved for payment and who was paid.

5. If my claim is denied, what do I do now?

If you see that the claim is denied, call the biller at the
office to see what caused the denial. It could be
something as simple as a wrong code. You can ask to have
the claim submitted again to be re-processed. Most offices
will do this automatically, but it does not hurt to call to
follow up.

6. I think I need a chart to keep track of all of these
claims. What kind of information do I need to record?

When you see that the claim is paid, you will record:

(i) How much was "approved";

(ii) How much was paid;

(iii) The date it was processed;

(iv) If the payment was to you or to the provider; and

(v) If the provider "accepted assignment" of the claim.

7. Do I deposit reimbursement checks or send them on to
the doctor?

If there is a check issued to you, deposit the check, then
pay the medical provider the same amount you were
reimbursed. Make a photocopy of the check for your records.

8. What if I have a second insurance policy?

If you have a second insurance, the medical provider's
biller will submit a claim to that second insurance company
after the first insurance's Explanation of Benefits form is
issued. You will then receive an Explanation of Benefits
(EOB) from the second insurance company for each item that
the first insurance company considered.

When you receive an EOB from your second insurance, you
need to record on your chart:

(i) How much was approved for payment;

(ii) The date it was processed;

(iii) How much was paid;

(iv) Whether the payment was to you or directly to the
medical provide; and

(v) Whether you have a balance due for your out-of-pocket
payment to the medical provider

If you have two insurance policies, then you will determine
how much you will have in "out of pocket" expenses for that
service, now that both insurances have processed the claim.

9. What is the "final bill"?

The third type of document you is the final bill, which you
will receive after all insurances have processed your
claim. It will show the amount of the original bill, each
payment from insurance, any "write offs" or discounted
balances and, finally, your balance due.

10. What if my "balance owing" does not match what is on
the final bill?

If you receive a statement from the doctor's office showing
a balance owing, and it does not match your records, call
the biller to ask for an explanation. If you do not
understand the terminology or jargon, keep asking until you
have a satisfactory explanation. You may want to have a
meeting with the biller so that you can present your
paperwork and show how you arrived at the amount due.

11. Why do I need to track every health insurance claim?

By tracking each claim as it works its way through the
system, you will know when an invoice arrives whether it is
simply informing you that your first insurance has made
payment, and you can file it away, or whether that claim
has been processed by both of your insurances and it is
time to get out your checkbook, if a balance is due.

Remember, if you use a recordkeeping system to keep track
of your medical billing, you will be more likely to get all
the benefits due to you from your insurance coverage. You
need to know that you are not paying out-of-pocket for
services that are covered by insurance.


About the Author:

Smalltown Duo, owned by Sibyl Day and Mary Benson,
specializes in medical and legal books for consumers. They
publish a popular book called "What Did the Doctor Say? A
Guide for Before, During, and After Your Hospitalization."
The book covers topics such as questions to ask about
medical diagnosis, medications, doctor visits, and avoiding
common medical errors. For more information, visit their
website. http://www.SmalltownDuo.com