Have you ever been the person who needs to go to the Emergency Room but holds off – because of the potential of high bills?
Of course you are! Everyone needs to worry about this. The trick is to be prepared! Well – that may be a little simplistic, but it is a smarter way to handle any emergency medical situation. Here are some tips to help make the financial end of any Emergency Room visit a little less stressful….
Insurance Tips to Know About an Emergency Room Visit
Read your Summary of Benefits and Coverage. Be familiar with what your plan coverage is for “Emergency Room” treatment. There is a wide variety out there. Some plans will levy a flat $100.00 copay. Others $250.00 or more. Some will waive the copay if there is an admission. Many plans will not add a separate charge but just levy a copay or coinsurance. Some will not pay any charges if you have gone out-of-network. But know this….your deductible will still have to be met before you see any reimbursement of charges accumulated by treatment in the Emergency Room.
Make sure you know which local hospital is in your medical insurance plan. The easiest way to do that is to look at your insurance card and find the number noted for “Members”. Give them a call. They will be very helpful. Explain that you are being proactive and ask for help narrowing down which nearby hospitals are in your plan. Do not make a mistake and call the hospital. Get the info directly from the insurance company as there are many different plans within each insurance company and you need to make sure that your specific plan is covered. That is best done by calling the insurance company.
While you have your insurance company on the telephone and if you are unsure of what your coverage is – ASK! They will go through the contractual obligations of what happens in an emergency with you.
This one is hard to do – especially when we all know that good care and health comes first, but if all possible, be smart about who is coming into the treatment room. Try to stay on top of who is coming in and out of the room, and what is being done. For example, if more than one physician is called into the room, ask who they are and why they are there. ER bills can rack up costs quickly. If the situation is fragile of course you can do little of this, but if all possible, try to be aware.
When you get home, write down what happened. What physicians (and their specialties) were involved. What tests were performed. It will come in handy later when the bill arrives, and time and adrenaline have passed. You need to be able to recall what happened to review the bill when it comes in.
Don't Pay That Bill Too Soon!
When you get your bill wait awhile before you pay it. Most of the time there will be more than one bill. One from the hospital, and one from physicians treating you. There could be an Emergency Room physician, a lab or radiology bill and of course a separate bill from any specialist that was involved in your care.
When the bills come in, be organized. Do not pay them until you have matched each bill up with the Explanation of Benefits (EOB) statement. Each provider will be treated separately on an EOB or be detailed line by line on a grouped EOB. A review of an EOB together with the final bills are the best way to determine what you owe.
This is the time to note what you were told or read in your Summary of Benefits and coverage. Was your bill within the lines of what your insurance told you it would be? Was your deductible met and the balances left are appropriate according to your coverage?
After you have reviewed the EOB’s against the bills and BOTH match the amounts that you are responsible for, take a look at your notes from the after-visit recap you did. Make sure that the care you are being billed for is in line with what your notes lay out. If there are charges in there that you disagree with, now is the time to make a call.
There is a specific reason we advise you not to pay on the initial bill. There will be a lot of computer cross going on between the insurance company and the provider. You want to make sure that the bill you are paying reflects all of the payments that will be or have been made by the insurance company. In addition, many times the insurance company will call out a provider on a code or cost and it is best that you let them duke that out before you get involved. Wait for the bill that shows payment from the insurance company, and then match it up with the EOB.
What Do These Codes Mean?
The Codes – the codes on each bill are important. Take the time to just type them into your browser, and see what an unfamiliar test or charge was for. If you do not remember that test or procedure it is time to dig a little deeper.
Call the insurance company first. Go through the bills that you are unsure of and ask about the charges. If there are charges that you disagree with, let them know. It is their responsibility to make sure that bills are being paid correctly. Often, the insurance company representative will call the hospital with you right on the line and ask for a broader explanation of the charges. Because you were “in-network” (which you were because you researched that before you even left for the hospital) a lot of the responsibility to make sure that things are right lie between the hospital and the insurance company. If there is a mistake you have a lot of support with this course of action - which is why you should always be prepared and make sure that you stay in-network.
One last thing – always at the end of a call with an insurance company, ask for the call reference number. Jot down the notes for each call and make sure you include the reference number. In each and every follow-up you have regarding this bill you have without question proof that you made the call and what information was relayed.
And finally….if the bill is overwhelming and you are unsure of the costs you are being charged, consider reaching out for help. There are many companies out there (Healthlink Advocates for one!) who deal with reviewing and straightening out these bills, acting as a liaison between the patient, hospital and provider. An advocate can obtain a copy of your treatment record from the hospital and do a line by line review, making sure that all charges are appropriate. We are always happy to help!