Special needs parents often have a BIG DAY (woohoooo!) that, really, will only truly be big to them. It probably doesn’t sound exciting to others. It may even sound weird. Like, the first day that you don’t have a g-button related spill in the house. Or the last dose you have to administer of a pesky medicine, be it one that’s hard to draw up, painful to give (shots!) or one that just smells or tastes ‘yucky.’ Today is a day like that for me. Today is the first day *since 2013* that we have no medical bills under dispute or review. *Everything* has sauntered through the “pending” pile to “paid.”
Why would I find reconciling and paying bills so exciting? After all, I don’t celebrate when I complete any of my other chores. It is because medical billing review is basically a part-time job for me and most other special needs parents. Last year alone, we had 257 health insurance claims (dental, vision and prescriptions excluded). It takes about the same amount of time to manage this paperwork as a job, and it pays the same in terms of money we save from the mistakes I find and correct. Yes, medical billing mistakes happen *frequently* so I carefully reconcile each bill to the Explanation of Benefits (EOB) from the insurance company before paying it. The most common mistakes I catch:
-Incorrect coding leads to denial of coverage by the insurance. Every supply and procedure has multiple medical codes, each meaning something slightly different, like if it was supplied as in-patient, out-patient, emergency, or routine. The difference in the codes is often a single letter.
-Referral wasn’t matched up for HMO coverage. We love the good financial coverage our HMO provides. We hate the referral system. Every time we see a specialist doctor or facility (we see DOZENS), our *primary care* physician (PCP) has to input a referral in order for the service to be covered, regardless of whether the PCP initiated the referral (often specialists refer us on to other specialists and we have to call the PCP to input a referral). Even when a referral has been made, sometimes the referral just doesn’t get matched up to the provider’s bill within the mysterious HMO digital world (Duplicate provider entries? Misspelling? Billed under a practice name instead of a physician? Billed under an interns name? Who knows, but I DID get the necessary referral, we just need to find it….), and the insurance denies coverage of the claim.
-Being billed twice. Often, especially at the children’s hospital, I will pay my copay in the office, but then get billed again for that same copay by mail. Typically that is because the copay from the office visit was actually applied to a different outstanding bill within the hospital billing system, without my consent or knowledge. I’ve put several ‘billing specialists’ through the ringer about this. I do not want my payments applied willy-nilly because it could easily be applied to a bill that is *under dispute* which I am purposely withholding payment on. Ascribing payments in this way could even wipe out a bill that I haven’t ever seen or been notified of, if it gets paid in the system before it is sent out to me, in which case I literally never know what I’ve been charged, much less approve of it.
I’m sure there are more billing shenanigans that I have to deal with regularly, but these are the three biggies. And today- the BIG day- is the first day in TWO YEARS that I don’t have any disputes pending or any mistakes unresolved.
Until we check the mail tomorrow.