10 Things to Look For When Reviewing Your Medical Bills

Is this really a medical bill?

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Ok... so you just got a medical bill in the mailbox, or maybe your e-mail.  Or did you? 

It may not be a medical bill!  Take a close look at what the document says.  There may be something as clear as, "This is not a bill!", printed right on the paper, but maybe not, so take your time really looking over everything!

If it says things like: 
1.  Patient Statement 
2.  Balance due: $X.xx 
3.  Due Date: xx/xx/xx 
4.  Pay this amount: $X.xx, or 
5.  If the document was sent by a physician, hospital, or other medical service or product provider,
  ...it is most likely a bill.

If you do not have insurance and you are a "self-pay" or "cash-pay" patient, then if you receive anything with an amount on it, it is most likely a bill.  Meaning you still owe something on the product or service and the provider is asking for payment.  

Another good sign that it is a bill, is when it includes a return envelope - especially if it is already addressed to the Payment Processing Center.  

If you do have insurance, you'll need to examine the documents further to determine if it is an actual bill.  

If it says things like: 
6.  Explanation of Payment

7.  Explanation of Benefits

8.  Remittance

9.  Reprint of electronic remittance, or

10.  If the document was sent by your insurance company  
...it is most likely not a bill.  

If you do have insurance, this is when you really need to examine your documents.  Often times, the insurance company will mail out an Explanation of Payment (EOP) or Explanation of Benefits (EOB).  These documents are NOT bills.  They are basically a summary of the services or products the provider is billing for.  

I like to think of EOP's and EOB's as a kind of security blanket for patients.   If your insurance company doesn't mail you one automatically, you can call them at the number on the back of your insurance card and ask for one.  Many insurance companies offer a patient portal where you can review, download and print these documents online or even in an app on your phone.  These documents will usually list everything from the dates the services or products were given, to fees charged by the provider, how much your insurance company is willing to cover and what portion of the balance that the insurance company is stating is the patient's responsibility.

Even if an EOP or EOB says "Patient Responsibility" - it is usually not a bill!  The patient responsibility listed can simply be the insurance company stating that you were responsible for a co-payment, which you probably already paid at the time of service.  Or it could very well be that the provider's billing office made an error and the insurance company is denying payment on a specific product or service.  Believe it or not, it could also be that the insurance company made an error and is stating that the patient is responsible for a portion of the bill that they are NOT responsible for.  I'll go into this a bit more in my next blog post: "What does Patient Responsibility Really Mean?".  Once that post goes live, I'll make this title a clickable link.  

Thanks for tuning in and remember most times we are our own best advocates.

"I learned a long time ago, the wisest thing I can do is be on my own side, be an advocate for myself and others like me." ~Maya Angelou

Cat Clayton's bio

Bio: Cat Clayton

Cat Clayton has had a very rewarding career in the Medical Billing & Auditing industry.  She started her training in 2014 with a 3rd party billing company in Fort Worth, Texas, where she was hired as a Medical Billing Follow-up.  Within 18 months she obtained two advancements, which led to a Team Lead position.  In that position she was responsible for educating, coaching, and motivating a team of 6 other employees in billing, coding, and auditing.  She and her team successfully maintained over 20 accounts with physicians all over the DFW area in various specialties, focusing especially on Evaluation & Management.  Since that time, Cat has obtained three certifications through the American Academy of Professional Coders (AAPC) including Certified Professional Coder (CPC), Certified Professional Biller (CPB), and Certified Professional Medical Auditor (CPMA).  

At the end of 2017, Cat realized her passion for the industry could not be contained and sharing her skills within just one organization wasn't enough, so in January 2018 she founded Monarch Medical Billing Solutions, where she offers a wide variety of services to assist physicians and their staff with billing and compliance. She offers services such as charge entry, claims submission, claims review, appeals, and collections; among others, and specializes in E&M Auditing.  In addition, she has developed a curriculum and offers private and group tutoring classes (both in person and online) for anyone wanting to begin or grow a career in the industry. She also offers Patient Advocacy services to assist patients by helping them to understand their insurance plans, medical bills, and to ensure the procedures and services they are being billed for, are accurate.  She began a medical billing blog in mid-2018 to further help educate anyone interested in the medical billing world.  She works with both local and national clients and lives in Fort Worth, Texas.