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Itemized receipt example for Operations

so you just got stuck with a big medical bill and you're wondering to yourself do i really owe this much and why did my insurance cover this and how come i was not told that i was going to have to pay this much out of pocket this is not an uncommon scenario in fact this recently happened to me hence the reason i'm doing this video i had a diagnostic test subsequently received the bill from the medical provider and i was pretty shocked to see how much i actually owed so being proactive about it i was actually able to get that bill lowered and in this video i'm going to go over some tips and tricks how you can potentially lower your medical bill now it has been shown that 8 out of 10 medical bills contain some sort of an error up to half of the time an error can actually lead to overpayment or overcharging now think about it medical billing is a really complex process and it has to go through numerous different people it has to be put into computers numerous different times and there's a lot of room for error first of all the doctor has to see the patient in their office and come up with a plan they have to document that plan and then they got to input specific diagnostic codes and they got to input specific testing codes to get the test that they want this information then goes to the front desk and at the front desk they have to take a look at the tests that were ordered input those codes and use the patient's insurance company to get authorization and they got to schedule the test all right now the test is scheduled for a particular day and the tech who's performing the test has to perform the correct test and make sure that's documented appropriately as well and finally the billing department has to submit those codes to the insurance company to be able to get payment received and the balance that's left over will subsequently be charged to the patient so obviously you can see there's a lot of avenues here where errors can occur sometimes just simple clerical errors even a single digit that's altered by accident could lead to a completely inaccurate bill so what should you do here's a couple of tips first of all make sure you request an itemized bill this itemized bill should contain cpt codes cpt codes are the procedure codes that are used to identify the particular procedure or test that was performed and that is what's utilized to actually put out the charge to the insurance company and subsequently the balance towards you however sometimes a cpt code could be put in incorrectly even a single digit altered could lead to you being stuck with a bill that you don't actually owe so make sure you get all the codes and then google those codes if you google the cpt codes you can see exactly what procedure is associated with it and if something does not sound familiar reach out to the building department of the office or the hospital is charging you and try to get clarification also some website you can go to such as fair health and health blue book that will give you an idea of what the charges are on average for particular procedures diagnostic testing and codes so that you know you're being charged appropriately you should also always request a copy of your medical record make sure that what's documented by your provider is accurate make sure that the testing that they requested is actually the testing that was performed and the one that's on your bill because a lot of times discrepancies can be there and errors can occur and that can often be corrected and if something doesn't make sense or there's a question about something bring it up with them because a lot of times these errors can be easily corrected next make sure you talk to the insurance carrier because the insurance company should be able to provide you an explanation of benefits right they're going to be on the receiving end of what the provider or the medical health system is sending to them and you want to make sure that their information coincides with what you're getting from the doctor or the medical group if there's a discrepancy there and something doesn't match up another possibility for an error another thing that you may have heard a lot about is this concept of surprise billing or balance billing this is a situation that usually occurs on the inpatient side where someone is going in for an emergent situation for example their appendix burst and they need urgent surgery and the anesthesiologist who happens to be on call at that particular hospital is out of network from your insurance carrier so what happens is the insurance company will ultimately deny the charge from that particular provider and you'll get stuck with the bill in fact i like to call this unpaid insurer bills because that's really what it is that often puts the patient in a very difficult position now a lot of states out there have laws that protect the patient from these scenarios and force that to be reconciled between the insurance carrier and the doctor in a fair manner however a lot of states don't have that the good news is in one of the recent coronavirus relief packages it's going to be a federal law that patients will be protected from the surprise billing phenomena and they're going to make sure that to sort it out between the doctors and the insurance companies it's going to be done in a fair manner with arbitration and not favoring the insurance companies which is what a lot of us physicians were concerned about in some of the earlier versions of the law but nothing they have to worry about from a patient standpoint but for the physicians out there this is definitely a win for us and takes some of the power away from the insurance companies into the hands of the doctors and the patients finally understanding your insurance coverage and what you're responsible for up front is always a good idea so if your doctor orders a procedure or a diagnostic test you can always contact the building department of that office or that hospital and figure out what is going to be responsible from your end up front so you're not surprised on the back end if something occurs or an error happens etc it's always a good idea to also know specifically what type of insurance plan you have whether it's an hmo ppo you should understand what your deductibles are what's covered what's not covered information is power and knowing this information up front and making sure you're aware of it is the best strategy so in summary medical billing errors are rampant okay and you should take that into consideration when you're getting medical bills don't blindly pay a bill if something does not seem right sometimes it's going to take a couple of phone calls a little bit of digging but you'll be surprised how often you're going to be able to get your bill lowered and mistakes corrected which will be well in your favor so thank you for watching this video please consider subscribing give me a thumbs up on this video turn on the bell notifications if you 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