The Three Sources Of Verifying Financial Responsibility

by Tiernan O’Neill

Now more than ever, patients are seeing their financial responsibilities, burdens and debts increase when receiving medical services. It is probably one of the largest complaints and frustrations of patients; especially considering the everchanging insurance guidelines and rising premiums. However, there are sources at their disposal that individuals can use to verify and possibly even lessen the money they see leaving their pockets for services received.

The first source is the insurance company itself. I always recommend patients know the limitations and benefits of their plan. While the clinics or facilities you use are aware of many guidelines, the insurance companies fail to provide a comprehensive guide; and ultimately the financial responsibility will be yours. Knowledge of your plan comes from two main sources. First, do not throw out that benefit booklet (like so many of us do) that you receive when you first enroll in your plan or anytime the group policies change. It is a fairly comprehensive and invaluable tool to understanding your benefits and limitations. But most importantly, it is sound advice to call your insurance company prior to receiving big ticket procedures. Many times, your clinic can provide you with information to include diagnosis and service codes to assist in these conversations. By calling your insurance company you can get a better sense of what your expenses may be to financially prepare for or possibly weigh the risk/benefit of having the procedure at all. But most importantly, be sure to time-date the call and know who you are talking with. I say this because regardless of your plan guidelines, and any disclaimers they make regarding a promise of benefits, insurance companies for the most part will be held responsible for any expenses which are in contradiction. I have seen many times where insurance companies, when instructed to pull the call log, will cover services a representative erroneously stated would be covered. The second source is the clinic or facility where you receive the services. While these places are knowledgeable to insurance billing, that is not to say mistakes don’t happen. What you are trying to do is simply verify whether they have processed the claim and your expenses properly. I would always recommend meeting with the person in charge of billing directly. Receptionists rarely have the full scope of what they see when it comes to viewing/understanding your insurance determinations. Also, general staff will never have the power or authority to make corrections. I strongly suggest you set a face to face meeting with the designated biller. I say this because you don’t just want to pop in and ambush them. Aside from the “confrontation” or wait, a scheduled meeting will usually allow the staff involved to have all of the pertinent information at hand and more importantly reviewed for any potential internal mistakes. In the case where they find a mistake ahead of time, this may save you a trip to discuss the problem.

The third source may be the physician’s office which referred you to the external facility or clinic in the first place. Now tread lightly here because many times the referring physician’s office may have little knowledge or authority to

assist; and you most certainly don’t want to expect them to take over your responsibilities or burdens. But sometimes they may be a good resource to verify using their professional knowledge and experience if bills or other things sound correct. Also, considering they are the originating source of referrals that tends to mean they have established relationships with those external facilities and may have better contacts or credits built with those places which can help you in the process. Having said all of the above, keep this one most important thing in mind as you navigate the process and sources. It is easier to attract bees with honey, coming into any situation or approaching any other person in a confrontational or disrespectful manner will likely not produce any desired or positive results. These sources are your best contacts, and they tend to hold enormous abilities they may use at their own discretion. Also, establishing professional and mature relationships with these sources is typically not an isolated event. Your reliance, cooperation, and understanding with these individuals should always be respectful and genuine regardless of the outcome. Remember, they rarely, if ever, advised you in signing up for one plan rather than another with better coverage.

Lastly, if at the end of the day you are faced with a correct bill that may be too burdensome to pay off due to any circumstance you are personally going through, communicate that with the facility promptly. Many offices will be more than happy to create payment plans, possible discounts, or direct you towards assistance programs in order to make sure all liabilities are met for services rendered. This is something that should be done promptly, as billing departments and offices are less likely to assist individuals who evade and neglect their financial responsibilities, and also have burned up the resource of the office to track them done. Ultimately, I wish all patients the best of luck as even I know this can be a difficult and confusing process. Even for those with personal/professional experience and knowledge.