And Yet, She Persisted: A Powerhouse Patient Gets Help with Medical Billing Errors and Resolving Insurance Disputes By Julie Buyon

By agebuzz Contributing Editor Julie Buyon

It’s safe to say that most of us have received a surprise – and perhaps incorrect – bill for medical services. Where to turn for help when this happens? A Powerhouse Patient knows there are many ways to get help, but often you are your own best advocate. 

If your surprise bill is from a hospital, a new federal law, the No Surprises Act, offers people with private insurance additional safeguards that already exist for Medicare and Medicaid beneficiaries. Even with this additional protection, health journalist Dan Weissman cautions that the new law leaves out a lot of medical care, so check out this summary of what the Act does and does not cover here.

Regardless of your insurance provider, with patience, perseverance, persistence, and detailed documentation, a Powerhouse Patient can usually prevail. 

DIY:  First, try and resolve things on your own. This is often the simplest and quickest method. Pull out your trusty healthcare notebook so you can DOCUMENT your efforts to resolve the issue, remember with whom you spoke and what was discussed, keep things on track, and hold others accountable. Do this for every phone call and email.

Call the healthcare provider’s billing department to understand more about the charge. In your notebook, note the day and time of the call and the customer service representative’s name, along with a summary of the call and specific dates for next steps if things are not resolved during that call. Follow up with another call on the date specified, and reference your previous call, including the date, time, person with whom you spoke, and the expected resolution. It can be very powerful to be able to say, “When I spoke with your representative Susan on March 15 at 10:15, she said X.”  You’re letting them know you mean business and are keeping a detailed record.  If the bill remains unresolved, speak with your insurer and describe the efforts you have already taken to resolve the matter

A Little Extra Help: Many insurers will help resolve a billing issue. You may have been incorrectly billed or the healthcare provider did not use the proper code. Follow the advice above about keeping detailed notes and review the advice and tips provided by the Patient Advocate Foundation for appealing an insurance denial. In fact, bookmark this link to multiple guides from the Patient Advocate Foundation on insurance denials and appeals.

A Lot of Extra Help: If you are unable to resolve the issue on your own, ask for help from:

• A medical social worker at your hospital or from a disease advocacy organization.
• The hospital financial counselor if it’s a hospital bill. Report violations of the No Surprises Act to the federal hotline at 1-800-985-3059 and/or submit a complaint online.
• Your state and national elected representatives. We forget that our elected officials work for us and have staff devoted to assisting constituents! Find your national and local representatives at USA.Gov.
• The amazing Patient Advocate Foundation offers free case management for patients and families living with a serious or chronic health condition. Call them at 800-532-5274.
• The fabulous Medicare Rights Center also offers free counseling and advocacy for Medicare beneficiaries. Their trained staff and volunteers can help with coordinating Medicare with other insurance, appealing denials of care, determining eligibility for Medicare cost-saving programs, as well as other topics. Call 800-333-4114.

Resolving these disputes is not fun, but perseverance will likely pay off.  Last fall I had a billing dispute about physical therapy sessions that had ended more than 6 months earlier.  Over the course of 6 weeks, I spoke with 4 different customer service agents, taking detailed notes each time.  Finally, as the fourth agent offered to send the dispute “out for review” yet again, I said that I considered this to be harassment and that I would be filing complaints with my members of Congress. “Let me see if I can do one more thing,” said the agent, and by the next day, the issue was resolved in my favor. I persisted, and you should too!

Julie Buyon is a palliative care patient advocate. She has professional and personal expertise in assisting people with complex illnesses navigate the health care environment. Julie’s role is to help patients feel empowered, and her agebuzz posts are intended to make sure agebuzz readers have all the tools and info they need to advocate for themselves and their loved ones. Julie would love agebuzz readers to email her at [email protected]with any questions or problems encountered with the health care system, and she will do all she can to address those issues in upcoming blog posts. She also welcomes feedback regarding her advice or recommendations. Read all of Julie’s agebuzz posts here and get in touch with Julie now at [email protected].