Organizing Insurance Paperwork
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How to keep track of medical expenses
Oct 2005
I would like to have some advice about how to
1) keep track of medical expenses, which are partially covered by our health insurance
2) keep track of EOB received from our health insurance company (United HealthCare).
I would like to know how someone with large medical claims with problems with his or her insurance company to efficiently file and organize all the documents.
The thing is,,, our health insurance company keeps making mistakes with our claims, such as covering only out-of-network lower percentage to in-network facilities/doctors/providers, forgetting to cover 100% even though we have already met our annual maximum out of pocket expenses, forgetting to apply RAP exception to anesthegia doctors'fees even though they have been performed at in-network facility with in-network doctors, etc, etc.
I do return the claim back to have them reconcidered yet they keep making mistakes. As a result, I have started to receive statements from medical facilities and doctors' offices based on incorrect EOB that they received from our insurance company. My husband's benefit department has been helping us minimally, and what is left to me is almost a full time work of calling/filing/sorting/tracking medical bills and EOBs. We have also made more payments than we needed to as a result. I am being patient to deal with everything with our insurance company and they are currently supposed to be going through all of my son's medical claims to correct mistakes, yet they still are sending wrong EOBs even now. It is getting extremely time consuming and stressful.
Have anyone had any issues with your insurance companies' incorrect claim handling, and how did you effectively solve your problems? Does anyone have any good ideas about how to keep both medical bills and insurance company's EOBs so that I can access information more quickly? Any advice is appreciated. I want to spend my precious time for something fun with our family, not for our insurance company's mistakes. Mika
You are not alone! I went through maybe a milder version of this problem, and it's unnerving, especially when you're already going through some medical problem. The New York Times just ran an article on this subject on Oct 13, 2005. Title is ''Treated for Illness, Then Lost in Labyrinth of Bills,'' by Katie Hafner. Try to read it. Some of the situations got so complex that people hired help just to untangle the bills (example was a social worker who knew how to navigate the system). Maybe you can find someone like that. I feel for you; as I closely monitored bills, I found mistakes constantly. It really makes you wonder who's minding the store. brluck
The New York Times ran an article about this problem on October 13 titled ''Treated for Illness, Then Lost in Labyrinth of Bills''. The article painted a bleak picture of this problem and didn't offer clear solutions. One quote from the article: ''The system is so impenetrable that it mystifies even the most knowledgeable.''
They did mention an instance of a patient hiring a consultant (Lin Osborne) to successfully straighten out billing problems. I did a Google search ''Lin Osborne medical billing'' and landed at this page that might help you:
http://www.billadvocates.com/find/advocate_by_state.htm#California Wading in Medical Bills, Too
Dealing with medical bills and insurance claims
May 2003
This is a confession and cry for help from an organizationally-challenged person. Perhaps someone can say how they deal with this. I can not seem to come up with a good system for dealing with my medical bills and insurance claims. I get a bill, but don't pay it because I'm waiting for my insurance to pay its 80%. But then I sometimes don't keep good track of whether insurance paid it or denied it, until the hospital is sending me to collections. At which point I pay (sometimes the whole thing) to avoid bad credit. Obviously I am a good candidate for a hassle-free HMO, but I like the freedom of my PPO. I am currently putting all my medical bills and insurance statements in one folder, so I can go through them. Is this what others do? Do you have a different folder for different months? Or keep a log of medical expenses? (Why so many bills: 2 of my family members had surgery this year). Thanks for any suggestions!! Befuddled By Bills
Yes, it is complicated! Here's what I do Each day, I sort my mail, putting important bills and reciepts into a pretty box on my desk. Each Sunday, I pay my bills and process the medical paperwork at the same time. For a medical bill I paid out of pocket, I send my insurance company a claim form. Then I file a copy of the claim form and reciept in a folder called ''medical waiting.'' Also in the box are claims statements from the insurance company. I open the statement and go to the ''medical waiting'' folder and try to match it up with a claim that was filed earlier. Then, when the issue is completed and resolved, I staple it all together and file it in another folder ''Medical complete.'' If I get a bill from a doctor before my insurance has paid on it, I write on it ''waiting for insurance company'' and file it in the ''medical waiting'' folder. Once in a while, insurance company needs a call (theyve lost the claim or some other problem) and I just keep a note on the bill or claim and refile in ''medical waiting.''
Other tips: I take a highlighter and highlight the providers name and the date of service on the claim form. It helps to distinguish it from the other paperwork, otherwise they all start to look alike.
Also, if your insurance company has a contract or relationship with the provider, there is a limit to how much you have to pay. Sometimes you are billed more, so look out for that. After your insurance company pays on something, wait for another bill fromt he doctor and compare it to the claims section ''it's your responsibility to pay $x.00.'' You can make a copy of that and send in your balance, sometimes saving a few bucks. Good luck!! finally have a system
My system for keeping track of medical bills is to have an ''unpaid bills'' file and a ''paid bills'' file. I keep everything I get about a particular charge paper-clipped together in the ''unpaid'' file until I get the ''Explanation of Benefits'' (EOB) from the medical insurance which says that they've paid (or not!) their share of the expense. When I get the EOB, if that has settled the claim, I staple the whole packet & transfer it to the ''paid'' file.
I keep a piece of note paper with each unpaid claim so that when I have to call the insurance company to find out why they still haven't paid the claim, I write the date, time, name of the person(s) I talked to and what they said. If the provider is protesting lack of payment, I call them up and explain that the insurance company is taking its sweet time to pay up. Sometimes the provider made a mistake in the filing, and I go back and forth getting this straightened out. It's a ridiculous hassle.
It's a bad idea to pay the insurance company's portion because then the provider gets paid twice and they take their sweet time to reimburse you. Once a provider tried to get away with not reimbursing me, I think she hoped I would forget.
If the insurance company is taking so long to pay that your account is being sent to collection (try to persuade the provider not to do this), you can be very stern on the phone with the insurance company, try to speak to a supervisor and threaten to contact the California Insurance Commissioner. If that doesn't work, send a letter to the Insurance Commissioner detailing your problem and cc it to the insurance company. The Insurance Commissioner will send you a claim form, but the insurance company always paid up right away before I had to file the claim. It's amazing how well that works. Louise S
I have a binder devoted to medical bills, and a section (indicated by binder dividers) for each member of the family. I place all of the paperwork in that, in date order, and keep all of the paperwork for each visit stapled together. I keep bills (the ones that the office sends to you while they are waiting for the insurance to pay) in our bills-to-pay file. Even if I just look at them each time that I am paying bills, it reminds me that they are outstanding. Good luck! Melissa T
I have just the ''thing'' to help you with this and probably a few other similar issues a person. We've used Kasey Brenner to help us get organized, and she's fantastic. She affordable, intuitive, and will work with you to put systems in place that will make you wonder why you struggled for all those years. We can't say enough good things about her and the time and frustration she's saved us. You can contact her at kaseybrenner at msn.com or at (510) 893-2720 - Robert
Hi, if your health insurance is through your employer, sometimes they have sway with insurance companies (since they are the customer deciding to use that company) or they might have a broker or advocacy service available to help you. It's worth inquiring. It would be your employer's human resources department or benefits department that could help. I had a big problem once with insurance when I was on leave, and when I came back, the benefits team was like, why didn't you tell us, we could have helped? So maybe they can help you. Best of luck.