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How to Manage Your Medical Finances

by Pamela Moore

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Healthcare providers may have support systems in place for their patients’ physical, mental, and emotional needs, but they generally don’t address the financial and accounting issues associated with dealing with long-term medical care. The stress caused by stacks of medical bills and insurance forms can undermine the healing process of someone with cancer. As a cancer survivor, I am familiar with the difficulty of navigating medical finances while coping with medical decisions.

You might overpay for your healthcare simply because you don’t have a good tracking system for managing medical finances. I believe an educated patient is an empowered patient. You and your caregiver need to take the time to learn about your insurance benefits, audit all forms from the insurance company for accurate information and benefit calculations, and try to always review the Explanation of Benefit, or EOB, forms for patient responsibility before you pay a provider bill.

The person designated to oversee the medical finances should carefully record non-insurance medical expenses along with insurance related expenses. One excellent resource for capturing medical tax deductions is the IRS Tax Deduction list. This enables you to capture non-insurance related medical expenses. This list can be a valuable tool for your medical expense summary at the end of the year. Make sure that all medical expenses are included for tax preparation: prescription costs; non-insurance costs; and all co-pay, deductible, and patient responsibility expenses.

You might overpay for your healthcare simply because you don’t have a good tracking system.

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Pamela Moore

The following strategies will help you take charge of insurance-related medical accounting:

  • Find an adjuster at your insurance company who is willing to assist with your particular needs and issues.
  • Find one contact person in every office of your major providers.
  • Send all correspondence via certified mail.
  • Stay current with insurance claims. Resubmission must be requested before one year from date of service. Remember, you want to review your EOB outlining patient responsibility before you pay the provider.
  • Document every encounter you have with anyone providing billing, insurance, or claims information.
  • Always pay your co-pays with a method that provides documentation, such as by check or credit card.
  • All correspondence should include complete information: date of birth, social security number, and account number.

These general auditing tips will help you navigate through the insurance/ provider system:

  • Understand there can be errors on medical billing from provider business offices; compare provider bills carefully to insurance company EOB forms.
  • Insurance errors will occur if you use more resources then the “normal” average patient. If you are a chronically ill patient, the insurance company computer will “kick out” charges because they are outside normal parameters. This error can be “fixed” by having your provider send a letter to your insurance contact person outlining your condition and the medical necessity for ongoing testing.
  • If a provider sends a bill that does not provide itemized information such as procedure code and date of service, you will be unable to match these charges to the insurance EOB. Call and ask for an itemized bill.
  • Do not pay a provider bill without having an EOB from the insurance company. When you receive an EOB, review these questions: Is there any portion of the charge not covered? What explanation is provided in the “remarks” section? Has the company calculated in-network versus out-of-network benefits accurately, and is the provider status accurate? Do you recognize the organization and/or provider name? Is any portion being applied toward your deductible? Has the company indicated a co-pay amount for an out-of-network provider? If so, the provider will need to resubmit.
  • Recognize that most circumstances are negotiable. Work with office managers to lower medical costs by asking to be classified as an “insurance only” payee. These negotiations are more effective if agreed upon before major hospitalizations or medical procedures begin.

You and your caregiver are your own best advocates in all aspects of your cancer journey. This information will assist you in taking charge of the financial component of your medical care.

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Pamela Moore, a chronic myelogenous leukemia survivor, has a Master’s degree in Hospital and Health Administration and over 15 years experience in healthcare management. Since 1999, she has assisted caregivers and people with cancer in becoming educated regarding the best strategies to use so that medical finances are accurately and efficiently managed.

This article was published in Coping® with Cancer magazine, May/June 2008.