As we step into 2021, we wanted to look back at 2020 and bring you our latest thoughts. Q2 was defined by lockdowns and insurance premium rebates to employers, but in Q3 we saw elective procedures bounce back and the confusing medical bills started to pour in again. This picked up in Q4 and despite the covid disruptions, brokers and employers continued to engage Bill Dog to help their employees. As we focus on saving brokers, employers, and employees time, money and hassles, we wanted to share statistics and three tips to help anyone deal with a confusing medical bill.
In the second half of the year, we saw medical bill reviews submitted by brokers, advisors, and employees range from a $37.91 EOB verification to a $32,561 out-of-network hospital bill. We saved members money on 61% of completed medical bill reviews and secured a median savings per review of $345.
We saved our brokers and advisors hundreds of hours dealing with medical bills and claims-related issues. When dealing with a confusing medical bill, here are three important things NEVER to assume!
Coding issues are a real issue and cause claims denials and incorrect payments by payers. We see in-network providers or PCPs fail to gain pre-auth codes or refer patients to out-of-network providers and labs. Beware, ER, hospital transfers, or ICU situations increase the probability of a coding issue. And, always double check a COVID test bill; we have seen high error rates.
Every provider handles billing and collections differently. We speak to providers on behalf of members and have started conversations only to find the outstanding balance to the member was zero! In some cases, a full or partial payment had been made by insurance, while in other cases, a portion of the balance had been written off. Beware, it can be difficult getting refunds in a timely manner-- It has taken as many as 3 escalations and 9 follow up phone calls over 55 days to process a refund for a member.
The transmission of data between providers and insurance is highly manual and governed by strict HIPAA rules. In many cases fax machines and snail mail are the only way to communicate. Don't be surprised if you have to follow up on documents several times and be prepared to ask a rep to check the incoming fax tray. It's common for faxes to be “lost” or “fail to go through.” In one case, a provider required 5 fax attempts to get a claim through to insurance. Beware, many insurance and providers have strict internal limits on the # of times they may follow up on an issue, after which it goes back to the patient to handle.
We continue to watch out for important coding updates, federal and state legislation on surprise medical bills and hospital price transparency rules. We will continue to post our updates here: https://www.billdog.com/blog. Please reach out if ever we can assist you, your brokerage, an employer or employee with a confusing medical bill or claims-related issue.
Thank you all and may everyone have a happy new year !