Let’s face it – medical billing is an integral part of any practice, whether patients are using insurance or are paying their bills out of pocket. Doctors, hospitals, therapists, pharmacies and other health care professionals cannot be compensated unless your medical bills are accurate. Your medical bills can also have a significant effect on you both personally and financially.
Medical bills are one of the factors that help determine a fair award for your pain and suffering in a lawsuit following an accident. Quite often, insurance adjustors and defense lawyers base their settlement offers on a pre-calculated multiplier of your medical bills.
Sometimes it is hard to understand what your medical bills actually mean. Far too often, substantial portions of your medical bills are written with your insurance carrier as its audience rather than the patient. That’s why it is important to have an experienced Miami medical malpractice lawyer or Miami personal injury attorney review your medical bills for accuracy during your claim.
Most patient billing errors happen due to technology or a staff member entering an incorrect diagnostic code onto the bill. This becomes more common on bills that total more than $10,000. Many of these mistakes are honest — a diagnostic code for an exam of both limbs when only one was examined, or a typo that results in a different and more expensive diagnostic code than the one that was prescribed.
The problem is that these errors can result in your insurance company rejecting your claim, making it more difficult for you to get the care that you need while simultaneously lowering the overall quality of your care.
Explanation of Benefits Letter
Accident victims typically receive two types of documents – a bill with your balance due and an explanation of benefits (EOB) letter. Your primary health insurance carrier, Medicare, Med Pay or Personal Injury Protection (PIP) typically generates the EOB when they process a bill for payment. The EOB should cover the following:
- Medical services and treatments provided
- Charges for those professional medical treatments or services
- How much the insurance carrier approved and if there is a difference between health provider charges and the amount your insurance pays
The EOB is not a bill but the EOB may contain important reasons why a bill was not paid, or why only a portion of the bill was paid. These reasons may prompt the need for action to assure that the bill gets processed for payment.
Bill for Services and Treatments
This is the document the medical provider sends that shows what is owed for a service. It may direct you to pay what is due while emphasizing the deadlines for those payments. Sometimes it notes no payment due at this time because insurance is pending. Carefully review bills and if you have an attorney assisting you, be sure to provide them copies of all bills and EOB letters.
Physicians are required by state and federal laws to accurately use the right codes for the services or treatments provided. There are certain codes for every kind of treatment possible and it is a medical provider’s responsibility to accurately represent the treatment they rendered or ordered.
What can you do to Question Your Medical Bills?
As a patient, you have the right to ask for an itemized bill from your medical provider. You can also ask your insurer for an itemization of bills they considered and bills they paid. You should demand such a list when you have any doubt what is owed. Take those bills and insurance itemizations and review them with an experienced South Florida medial malpractice attorney or South Florida personal injury lawyer for accuracy.
Letters of Protection
Often, victims of accidents, medical malpractice or harm from a defective product can’t pay all their medical bills as they come due. Sometimes there is insufficient insurance to provide adequate compensation or there is no insurance at all. Victims still need the proper care in order to recover. Some health professionals understand the financial strain many are under and in these instances and they agree to work under what is known as a Letter of Protection. Essentially, the accident victim and the attorney agree that the health care provider will be paid from the proceeds of any settlement or jury verdict once it is rendered.
Understanding your medical bills can be stressful, an experienced South Florida personal injury attorney can guide you through the process. Weinstein & Cohen has been handling accident and medical malpractice cases across Florida for over 30 years. We understand how big and small insurance companies work. If you or someone you care about has been injured or involved in an accident in South Florida or Southwest Florida, contact the Miami Lakes and Naples accident attorneys at Weinstein & Cohen at 305-374-1011 or 239-793-3331, or visit fairnessforall.com for an absolutely free and confidential legal consultation to learn more about your options.