By Trish Pearson
Insuring Your Future
Trish Pearson
Navigating the maze of medical information can be complicated these days. First, there is MyChart, which not only shows medical results but also provides cost information online. Then there is the member account information on the insurance company website, followed by paper bills from the medical provider.
Sound confusing? It is. The following are some simple steps to follow that will help to avoid long wait times on the phone and frustration with multiple phone conversations about something you probably don’t want to discuss in the first place.
Rule 1: Do not pay a bill from MyChart. Just as test results and medical notes are posted within days of your visit, so are the charges. Often the charges do not reflect insurance adjustments or credits. It is always better to wait to receive a paper bill after the insurance claim has been processed.
Rule 2: If the bill is not what you expected, do not pay until you receive the explanation of benefits that reflects the insurance coverage for the visit or procedure.
Rule 3: If you are not clear about the insurance coverage and your financial responsibility, pick up the phone and call your insurance agent, provider’s office or the member services number on the back of your insurance card. Be sure to know the date of service when speaking with the claims department.
Facility fees can also be very confusing. You may be asked to pay a facility fee in addition to the office visit copay. The state legislature passed strict laws regarding notification procedures for provider’s offices that may charge a facility fee. Many doctors have now affiliated with large hospital systems, and they may or may not be located in a building owned by the hospital. If there is a possibility that you may encounter a facility fee for your visit, the provider is required to notify you in advance.
Unfortunately, these notices can create a lot of confusion. Generally, if the appointment is a consultation or exam, there should not be a facility charge. However, if the doctor performs a procedure – even something minor – it can result in a facility fee. These fees can range from $15 to several hundred dollars depending on the service you receive.
Here are some things to know in advance regarding facility fees:
1. Check the doctor’s office website to see if they charge facility fees.
2. When making the appointment, ask if you will be charged a facility fee.
3. Request to see the doctor at a different location that is not in a hospital-owned property.
The bottom line is that you have the right to understand medical fees and the amount you owe. It may require some time and research on your part, but it can be well worth it. The providers are quick with the bills, but slow with refunds.