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We in America are blessed with medical care that is the envy of the world. Doctors, researchers and other medical professionals are working diligently to help heal their patients when they become ill or injured. This amazing medical care comes at what can sometimes be a significant cost, and wading through the billing bureaucracy can sometimes cause more distress than the illness or injury itself. It’s important to understand your rights and obligations if and when you ever have treatment for a serious illness or injury to pay for.


Explanation of Benefits


Explanation of Benefits, or EOBs, are notifications you receive from your insurance carrier. After you have been treated, the medical office will file a claim with your insurance. Insurance will review the claim, pay their share to the medical provider, and send you an explanation of what they have paid and the charges you are responsible for. It’s important for you to have your EOB on hand when you receive the bill from the medical provider’s office so that you can be sure the charges are correct. If you find errors, getting them corrected quickly is important. Reuters has a great article for what to do if there are errors on your bill. You can read more here.


Beware the “Out of Network” Charges


You’ll probably still be responsible for Out of Network charges but knowing about them ahead of time may help you avoid them. I found out the hard way that they were a “thing”.

I had surgery a few years ago-my thyroid had taken on a life of its own and had to come out. I chose carefully-the hospital AND the surgeon were both in-network so I felt sure that all the expenses would be covered by insurance and I would only be responsible for my deductible. What a shock I was in for! I received a bill for over $800 for one of the surgical assistants who worked for the surgeon’s practice but was NOT in my network. I appealed it with my insurance company and lost the appeal. My advice to you-if you’re able to schedule your procedures ahead of time, get as much assurance as you can that all of your medical providers are in network. I’ll know better next time!


Medical Debt – Negotiating with the Provider


If the bills you receive are more than you can handle, you can negotiate a payment plan with the medical provider. Your rights in this are very specific, and this article at TheBalance.com has some great advice for how to go about negotiating with the medical provider.

One thing to keep in mind when negotiating with your provider is their ability to report to the credit bureaus any unpaid balances. Back in the days before Older Wiser Money Miser, I allowed this to intimidate me to the point where it was easier to pay the charges than it was to argue about them. One of the things I wish I had known is found in this article by Clark Howard about the 180 day rule. Unpaid medical debt cannot be placed in your credit report until 180 days have passed, and anything paid by the insurer that has been reported to the credit bureaus must be removed from your file immediately.

One more word of advice when negotiating with the provider-keep EXCELLENT notes. Having the backup documentation at hand will serve you well when working with the billing office of your medical provider. They will appreciate it, and you will have the facts on your side.


Hiring a Professional


One of the things about negotiating medical debt is that the person doing the negotiating is often the person recovering from an illness or injury. Typically they do not have the energy to deal with all the bureaucracy. Hiring a Medical Billing Advocate may be your best option in this case. You can expect to pay between $30 and $50 per hour for their service but if it saves you thousands this will be money well spent. Once again consumer advocate Clark Howard has some great advice, which you can read here, for hiring a Medical Billing Advocate.


If you have any experience with negotiating medical debt that has not been covered here, please share in the comments. My other readers may benefit from your experience.


Be well and God Bless-until we meet again…


Note-Any and all items contained in the Older Wiser Money Miser Debt Free Challenge are intended as a resource for informational purposes only and should not be construed as professional tax, investing, or other professional advice.

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