Lupus, Caretaking, and Insurance: Tips for Challenging your Medical Bills

I called it the Day of Disputes. One day last month, I went head to head with the medical industry, three times over. I had to contest three medical bills - two for my mom totaling over $400, and one for myself for almost $500. After months of phone calls, left messages, and overdue bills, I think we may be close to resolutions. It takes so much work to fight, doesn't it? 

I've been working on my mom's two bills since the fall. Back then, I started with the lab company (thankfully the same for both bills), but was quickly routed to the individual doctors' offices, then on to each of their billing departments. (Tired already? I was!) Doctors got involved, diagnosis codes were discussed, and it seemed clear what needed to happen. But it never did. Months later, and even after several follow-up calls, the bills rolled in again. It was back to the lab company I went, where I asked for a hold to be placed on the bills while I sorted them out with the docs' offices.  I continued to run interference between the front office, the billing office, and the doctors - providing information to one that the other had given me. How had I ended up being the office go-between? 

It was a similar situation with my bill of almost $500. Once the bill came in, I rooted through my files, pulling out the Explanation of Benefits (EOB) for the same service from last year. The bill had been $0. So I called the doctor's office, explained the situation, and the woman I talked to knew exactly what I was talking about. She said she could see clearly why last year's bill had been covered, and this year's hadn't. It was a matter of the verbiage used for the service. She was going to add the same verbiage from last year's service to this year's, and resubmit. She assured me it should be no problem. She was so confident, in fact, that I almost filed the bill away because it seemed like such a done deal. But lo and behold, another bill arrived in the mail weeks later, for the same amount. I called the office again, this time talking to two people who had no idea what I was talking about. (Can you see the steam...?) They compared the two services, didn't see anything different between them, and had no idea what verbiage could have possibly been added because neither bill had been touched since last year. (Grrr.) I didn't have my notes from the previous call with me, so I politely got off the phone, screamed, and then called back a few hours later, once I could pull myself together and I had my notes in front of me. This time, I talked to a fourth person, relayed the verbiage the first woman had given me, and he was happy to add it. He escalated the bill, sent a message for the billing manager, and assured me that someone would be in touch. Here's hoping!

The good news is that most everyone has been very kind and patient. But at this point, I really just want the adjustments made and the bills resolved. 

While I await the outcome, here are my three tips for challenging your medical bills: 

1) Take notes - In the three cases above, I made notes during each of the calls I made and everyone I spoke to - both in person and over the phone. I jotted down diagnosis codes, medical jargon, names, numbers, and notes to remind me of who said what and when. At one point, I accompanied my mom to an appointment at one of the doctor's offices with whom I was working, and I left with post-it notes from both the front desk and the doctor regarding the disputed bills. I'm telling you - my notes saved me when I had to follow up. I was the one connecting the dots and filling in the blanks, simply because I could reference my notes. And as the bills were streaming in. I could see where I was in the process, and who I needed to call next. So before you make a call, grab a pen and paper! 

2) Allow time - I don't want to even think about how many hours I've spent on these three bills. But the saving grace is that I've learned that each time I make a call, I need to allow enough time to talk. Odds are that I'm going to be transferred, redirected, or given another number to try, and that takes time. I feel like I talk to an average of three people every time I pick up the phone. It's just the way it works. So carve out a chunk of time when you call so at least you're not stressed and can finish the job. You don't want to spend 20 min on a phone call, finally to be transferred to the one person who can actually help you, just to have to hang up because you're out of time. I think 30 min is about the minimum to allow, but goodness knows it can take double that!   

3) Keep your EOBs - I know it takes time, but I've caught a lot of billing mistakes by comparing invoices or EOBs from one year to the next. One year, I realized that my labs had been coded incorrectly, and thus weren't covered the first time they were submitted.  Another time, I discovered that the lab I'd always gone to was now considered out of network. A third time, I learned that insurance information hadn't been provided to the doctor's office, so the billing department didn't even know to submit it. You don't have to check every bill that comes in. But when one does arrive that seems out of the ordinary or abnormally high, you can pull out your EOB file, or pull them up online and get to the bottom of it. 

I'm definitely not saving you time with this post -sorry! But I am hoping to save you money. I'm hoping for almost a $900 swing in my favor. I'll keep you posted! 


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