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Fake medical bill generator for HR

it can be scary and upsetting to receive an unexpected medical bill since they're small and they're just confusing and frustrating but sometimes you can receive a rather large unexpected medical bill which can be quite frightening so in today's video we're going to go over some of the more common reasons why you might receive an unexpected medical bill why a procedure might not be covered or your medical claim might be denied now I do want to preface today's video by reminding you that yes we are licensed health insurance brokers so if you have any General Health Insurance questions you can absolutely reach us in the comments below or you can reach us at the number on the screen and of course there's no charge for our services but if you have more specific questions about a specific health care bill that unfortunately is not something we're going to be able to help you out with today if you do have a broker that you've worked with we definitely recommend that you give them a call they may be able to act as a liaison for you which is of course a service we offer to our clients and you can always call your doctor and your insurance carrier if there's a bill that you're uncertain about now we release these video was on a weekly basis so make sure to subscribe to stay up to date and of course please click that like button give us a thumbs up so we can get this information out there so usually screening services and preventative visits are offered with no copay so zero dollars however sometimes these screening visits might turn into a diagnostic visit for example something might pop up during the screening that might cause the doctor or billing department to change the coding from screening to diagnostic or they might run an additional test in the moment that you're not even aware of for example you might take your child to a regular pediatrician Wellness visit however during the visit perhaps your doctor notices that your child's throat seems a little red and they order a strep test or perhaps they're not meeting their milestones and they refer you to a specialist well all of a sudden you might have gone from a regular Wellness visit to a diagnostic visit now we're not saying that this is right and we're not saying that it's always the case it just might happen and it's something that you should be aware of if that's the case the medical coding might get switched from screening to diagnostic why there are intentional or not we've also heard many reports of people going in for routine mammograms and those medical codes can get changed from screening to diagnostic based on the results or whether or not the doctor refers the patient for additional testing now sometimes this can be intentional sometimes it could be a miscommunication between the doctor and the billing department so definitely contact your doctor and your insurance carrier to sort out this type of unexpected Bill another very common reason for receiving an unexpected or inaccurate medical bill is inaccurate medical coding sometimes the billing department may make an error and switch a letter or a number in the medical coding and entirely change the nature of the procedure or service that you've received now if you spot something like this in your explanation of benefits contact your insurance carrier immediately you'll need to explain to them the treatment procedure that you actually received and they should be able to follow up with your doctor's billing department to sort out the miscommunication now the statistics regarding the frequency of medical coding errors are quite frankly all over the place but one study indicated that 80 percent of medical bills included at least one error so please double check and triple check your explanation of benefits if there's something on there that doesn't seem quite right don't just pay it blindly contact your insurance carrier contact your doctor and follow up that being said you also can't just ignore an erroneous bill because you don't want it to go on your credit you don't want collectors calling you either so just follow up follow the proper channels of course it is very frustrating to have to correct a mistake that you didn't make but you don't want to deal with the repercussions and I will also just add that medical fraud specifically Medicare fraud are also much more common than you might think another extremely frustrating reason for receiving a bill or having a medical claim denied is when your insurance carrier deems the procedure service or treatment not medically necessary and there can be a few reasons for this first is of course pre-authorization now we see this with Medicare Advantage plans a lot especially when we're talking about hmos basically with an HMO yes you need not only a primary care physician but you need a referral from said primary care physician to go see see a specialist now even if that's the case your insurance may need to pre-authorize you to see The Specialist or receive a certain treatment if you are not pre-authorized you may receive an unexpected medical bill stating that that service or treatment wasn't covered so if this is the case you'll need to provide documentation or a letter explaining why the treatment or service was medically necessary now this is another reason why Medicare supplement plans are so much more popular than Medicare Advantage plans because there are no referrals and there is no pre-authorization your insurance carrier may also deem that your treatment was in an inappropriate setting so what I mean by that is sometimes your insurance carrier May determine that the treatment that you received would have been more appropriate through your PCP or through an Urgent Care rather than an emergency room and a hospital now sometimes something may feel like an emergency and turn out not to be and this can cause some confusion and frustration with your insurance carrier there is basically a Layman's rule that states that if it's something that a Layman would consider an emergency and you would need to go to the hospital then your insurance carrier should cover it so definitely go ahead and contact your insurance carrier and try to dispute this if something like this occurs it comes to your health of course it's always better to err on the side of caution you also want to make sure that you don't go out of network if we're talking about an HMO so if you have an HMO you need to operate within a network of doctors and hospitals should you choose to go out of network then your insurance carrier will not cover the bill this can become a little bit more problematic and frustrating when it comes to referrals because obviously your PCP your primary care physician is going to be in network but very often when you ask for a referral they give you one without really looking into whether or not that specialist accepts your health insurance then you go home you attempt to make an appointment and it turns out they don't accept your insurance and you have a lot of phone calls to make so if you do need a referral from your doctor make sure they are aware of your health insurance that way you skip a few unnecessary steps now in the case of a true medical emergency head to the nearest hospital it doesn't matter whether they are in network or out of network because under the Affordable Care Act your health insurance cannot charge you more for an out of network emergency room versus an in-network emergency room now prior to 2022 and the surprise medical bill ban you could actually receive a balance bill should you be treated in an out of network hospital so meaning the remainder basically of your bill which would be very frustrating and additionally sometimes people would go to an in-network hospital but they might be treated by an out of network physician while they were there and receive a bill for that out of network position very often this was not in people's control luckily this is now part of the law so if you do receive some type of bill from a medical emergency again you need to dispute this with your carrier because you cannot be charged more in a medical emergency for out of network versus in-network now as I said earlier as much as we'd love to be able to help you with all the specifics of your health care claim questions that's not something that we can do so we definitely recommend that you contact your doctor or your insurance carrier or your broker if you have one now if you do have additional more general questions about health insurance you can absolutely reach us in the comments below or at the number on the screen we are licensed Nationwide and there's absolutely no charge for our services so please feel free to give us a call but before you go make sure to subscribe to stay up to date and of course click that like button so we can get this information out there as always thank you so much for watching and have a wonderful day bye