Troubleshooting Tips

Get Organized

You need to be able to keep track of bills by source and dates of service and of billing; be able to correlate them to  insurance statements (called EOB or Explanation of Benefits) and actions on each; record your own interactions with billing offices and the insurance company; and note the payment status and needed actions for each bill. Many families set up their own system for managing bills using file folders and datebooks; other may choose to use computer-based tools or special software. The Care Organizer offered by CHRMC free of charge to WA patient families, includes a bill tracking form which can be copied and used to record all bills.

Verify all Charges

It is also critical to examine each and every EOB and bill for accuracy, as not infrequently they may contain errors. As mentioned previously, in order to verify the bills, you will need to understand your insurance  coverage: know exactly what your deductibles, co-pays, coverage exclusions, and the percent of personal responsibility for different aspects of coverage under your insurance plan. Some billing mistakes may be due to simple human error caused by a wrong keystroke, but others may reflect use of incorrect  codes, duplicate charges, wrong numbers of inpatient days billed, charges for services not given, etc., according to Consumer Reports. You can also request copies of your child’s medical records (very important also for your own information) so you can compare charges to services and tests received, dates of service, names of physicians, etc.

Monitor Insurance Benefits

Making sure that bills are correct and correctly paid is also vital to ensuring that your child can get the maximum coverage possible from insurance benefits, as insurance plans customarily have lifetime limits or maximum caps on the total dollar amount of benefits they will cover. With cancer treatments often extending over years, and including extraordinarily expensive procedures like BMT, it is not difficult for a cap of $1 million to be quickly reached. Therefore, just as you do with your personal finances, you must make sure that every health insurance dollar is properly spent and not wasted. Do not let anyone in a billing office tell you not to worry about bills containing small monetary errors because your “insurance will pay.”

Here are some addditional tips on dealing with medical bills, based on the  experiences of other BMT patient families:

  • Ask a friend or relative to take charge of the bills, so that you focus on the needs of your sick child and any other children
  • Ask for an itemized copy of every bill, as these are often not routinely sent. In order to check for the accuracy of bills, you need an itemized copy to be able to verify each charge
  • Keep a log of all phone calls and/or e-mails  made about bills to insurance copies or medical provider billing offices. Be sure to note dates, full names and titles of the people spoken to, and their direct phone numbers or e-mail addresses. Many people find it convenient to use a paper datebook or journal for this purpose.
  • Ask that one specific individual at each billing office be designated to handle all of your bills, just as you should do with your insurance company if you do not have a case manager (which you should also request).

The following articles may also be of interest:

Pediatric Cancers: Financial Records
OncoNurse/Patient Centered Guides

Personal Medical Records

8 most common hospital billing errors

Fight back: Malpractice in the billing department
Money Magazine