Streamline Your Billing with Invoicebus for Healthcare

Invoicebus for Healthcare

you sought services from an out-of-network provider with no contract with your plan and who is not part of your insurance preferred network can you still get reimbursed by your insurance welcome I am Martin Bruce your medical bill Whisperer committed to Bringing answers insights and solutions to patients just like you so can you get paid back well maybe let's get specific first then see if you have all the information you need I'll give you the 4-1-1 on how to file before sharing some useful tips the most important is your plan must offer out of network benefits EPO plans probably do not never do some HMO or PPO plans to know more on the types of plans out there do watch my special video here we'll address care you specifically sought not surprise Services surprise services are both imposed on you either rendered at an in-network facility or Hospital under normal circumstances which you had no control over anesthesiologist assistant surgeon lab hospitalist Radiologists or those services rendered as a direct result of an emergency these include the ambulance ER doctor emergency room Consulting Specialists Etc why Abby is not included because the providers usually Bill your insurance directly and because for services are usually covered under a new federal no surprise act and under some state laws which dictate and force interesters to pay more provide us to accept less thus reducing your liability today let's focus on Services you knowingly sought paid out of pocket and want to get reimbursed for I often see therapists of all kinds trained to address a specific condition autism lipedema stroke or mental health professionals treating particular diagnosis autism PTSD addictions doctors with very focused expertise such as a rare disease or those who are Pioneer in a new treatment also apply facilities offering a specific level of care or type of care are also seen why did you go out of network well maybe due to delays in getting an immediate and prompt appointment or because of a lack of a required expertise of your in-network provider choices would you pick a surgeon who's done two procedures like yours or one who does them weekly in-network options may be lacking close to your home your unusual diagnosis may not be served by a general practitioner for example the medication management for your bipolar condition cannot be handled by a marriage counselor your main physician may have written a specific recommendation or you may have been forced to use an out-of-network choice to get that second opinion the proper paperwork must include who is the patient who is the provider what are the services in order to be considered and processed the patient's info name address date of birth and diagnosis in the form of a code as determined by the provider the English description is not enough it should be indicated as an ICD-10 code the provider section must include names and credentials contact info tax ID number and NPI number this is the national provider identification a unique ID for every Medical Professional in the U.S as for service details they should show the place of service office Hospital home and the procedure code also called CPT or hectics the English description of a service for example office visit is not enough and last the number of units per service While most code equal one such as a consultation others especially both for therapists also have a time element so let's say a code is for 15 minutes but the service lasted 45 then the procedure code must show three units next to it is the provider's responsibility as part of their licensing requirements to build their services with the proper codes ideally you will receive the proper and completed invoice right away unfortunately my experience is that too often you must make a call to track down a missing piece of information unacceptable alternative is the Universal Insurance claim form submitting the paperwork is the easy part best is to upload your claim online through your insurance portal account step-by-step instrument instructions are easy to follow add proof of your payment if you already paid and it's not indicated on the invoice then we'll print out cash receipt credit card statement if you prefer to snail mail your the claim address can be found on the back of your insurance card do add the same proof of payment if you already took care of the bill now to recap if you have out of network coverage if your provider's invoice is complete your insurance should process the charges and you may get reimbursed something how much will depend on your plan and on the share of cost you may already have met for more on that share of cost do watch my special video on the topic as for tips if mailing or faxing make sure to include your insurance reimbursement or patient claim form to avoid delays or rejections this form is available online or an insurance phone rep can send you one if filing online an automatic confirmation will be on your portal or sent via email if not call your insurance after a couple of weeks to confirm receipt mailed invoices must be inputted manually and too often are mistakenly rejected or inputted wrong and too many offices and billing services are unhelpful at providing patients with proper documentation some might not even know what is needed to get a claim reimbursed or may not care do not let ignorance incompetence or ill will get in the way of you getting reimbursed you patients have rights insurance companies have a duty to you and providers have rules to abide by I do thank you for watching do consider helping this channel grow to reach out to even more patients just like you with your subscribe likes and comments thank you