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Is Your Health Insurance Overpayment Your Problem?

Health Care BillingThe answer is often “yes.” Our reader Sally found this out the hard way.

Sally had back surgery. Her insurance company overpaid her surgeon. How could this be Sally’s problem?

Sally’s surgeon was out of network. Since she was out of network, the insurance company paid Sally directly. Sally, in turn, endorsed the check over to her surgeon.

Two months later, the insurance company sent a letter to Sally stating that they had overpaid the surgeon and the insurance company wanted Sally to pay the insurance company back for the $6,500 overpayment. Sally thought this was absurd. How could she possibly know that the surgeon was overpaid? Sally asked me what to do.

First, before you endorse a check over to your doctor, always make a copy of the check and get a receipt. Luckily, Sally had a copy and a receipt.

Second, start with your surgeon’s office. Every office has a billing department. Explain the problem. Show the office the insurance company letter and ask them to reimburse the insurance plan.

Third, if the surgeon’s office won’t help, contact the compliance office at the insurance company. You should make sure you put everything in writing so you can show the insurance company that you attempted to get the surgeon’s office to return the money.

You might be surprised to know that overpayments happen about 20 percent of the time. This is due to coding errors or the insurance company processing payments for services that are not covered by the health plan.

Have you ever received an overpayment from your insurance company?   I’d love to hear from you!

MyHealthSpin helps you Spin Your Healthcare Your Way!

Check out how more information on insurance in our new book, Easy Healthcare: Choose Your Health Insurance.

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A Special Note for Our Military

Soldier And Doctor Shaking Hands With Flag On Background - UniteToday as we celebrate Memorial Day, I want to give thanks.

Thank you to all the men and women who are currently serving and who have served in the military. Thank you for protecting our country and our freedom.

Thank you for your time, your commitment, your caring.

Because you do what you do, I am able to do my work. So thank you.

Since my work is demystifying healthcare, if you are a veteran still in need of health insurance for 2015, check out the information on Healthcare.gov. Though open enrollment has ended, there may still be some options for you.

Stay healthy, and once again, thank you for your service.

MyHealthSpin helps you Spin Your Healthcare Your Way!

 

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Has ObamaCare Slowed ER Visits?

Doctor with female patientSurprisingly, no. Most hospitals report that ER visits are on the rise. Three quarters of ER doctors report that since ObamaCare has been in effect the ER is seeing more patients than ever before. This is contrary to the goal of ObamaCare. What happened?

There are a lot of different answers.

  1. People have insurance but there are not enough primary care doctors to see them.
  2. ObamaCare expanded Medicaid and many primary care doctors won’t accept Medicaid due to its low reimbursement.
  3. The newly insured cannot take off work to see a primary care doctor or lack transportation or child care. (Source: USA Today Article)

All of these factors make the ER often the best or only option.

Should you use the ER for your healthcare? Not if you can avoid it.

  1. Call your insurance company and ask for a recommendation to a primary care physician. If you have a Medicaid HMO, a primary care physician will be assigned to you.
  2. Schedule your first appointment when you are not sick. It is important to establish a relationship with your doctor BEFORE you are so sick that you get referred to the ER.
  3. Pick a doctor who has late night or weekend hours if you can’t miss work during the week. Many physicians are now offering more convenient appointment times.
  4. Be proactive and take responsibility for your healthcare. It’s the only way to stay healthy and avoid expensive ER visits.

Have you ever gone to the ER and wished later that you had not? I’d love to hear from you!

MyHealthSpin helps you Spin Your Healthcare Your Way!

Check out how more information on insurance in our new book, Easy Healthcare: Choose Your Health Insurance.