PROTECTING YOUR FAMILY'S HEALTH & FINANCES

To safeguard your family's financial and medical well-being, it's essential to remain vigilant. These five steps can help to establish a strong foundation and proactive process for managing family healthcare costs:

1. REGULAR REVIEW

Schedule regular times each month to review new medical bills and EOBs. Staying proactive can help you catch errors early. At the beginning of each new insurance cycle, thoroughly review your policy to understand its terms and coverage limitations, as well as any changes from the previous coverage year.

2. KEEP RECORDS

Maintain organized and secure records (both physical and digital) of all medical bills, receipts and healthcare-related paperwork. This makes it easier to spot mistakes or quickly address any issues arising from old claims.

3. QUESTION DISCREPANCIES

If you find any differences between the EOB and your healthcare provider's bill, contact your insurance company for clarification and next steps.

If you find any differences between the EOB and your healthcare provider's bill, contact your insurance company for clarification and next steps.

4. APPEAL CONCERNING CLAIMS

If you suspect your insurance provider has denied a claim due to an error, follow the appeals process. This is specific to each insurance carrier and may involve providing additional documentation and putting together a detailed case for approval. Parents can take this on themselves or use a service that negotiates appeals on their behalf, to save valuable time and avoid countless rounds of phone tag and hours on hold.

5. GET KIDS INVOLVED

Empower your children with medical literacy and involve them in healthcare decisions, especially their own. Teaching them how health insurance works and helping them implement wellness-fueling habits will show them how to advocate for themselves, and keep them healthy for years to come. This is particularly crucial for children with special needs, as they transition to adulthood.

While billing mistakes already pose a significant concern, an even more sinister issue lurks; medical fraud. Fraudulent medical claims can take on various forms, including billing schemes and identity theft, which can put your child's healthcare at risk while draining your financial resources. A few common examples of medical fraud include:

• Phantom billing: Healthcare providers bill for services that were never performed or weren't medically necessary. 1. REGULAR REVIEW Schedule regular times each month to review new medical bills and EOBs. Staying proactive can help you catch errors early. At the beginning of each new insurance cycle, thoroughly review your policy to understand its terms and coverage limitations, as well as any changes from the previous coverage year.
• Upcoding: This occurs when a provider submits a bill with codes that represent more expensive procedures than the ones performed.
• Identity theft: Criminals may steal your child's personal information to obtain medical services, which can lead to incorrect bills and compromised healthcare records.

IDENTIFYING RED FLAGS ON MEDICAL BILLS & EXPLANATIONS OF BENEFITS

Understanding key indicators of common billing errors and being able to identify them early in an Explanation of Benefits (EOB), the document your insurer provides outlining medical claims prior to provider billing, is the first step in protecting your family. Here are some red flags to look out for on both bills and EOBs:

• Unfamiliar charges: Review your medical bills and claims carefully. If you spot charges for services that you don't recognize or remember, investigate further. It may also be beneficial to use a free tool like Medical Dictionary Online (online-medical- dictionary.org) to look up unfamiliar terms, as well as, brush up on Current Procedural Terminology (CPT) (verywellhealth.com/what- are-cpt-codes-2614950) codes to ensure the correct service is being billed for the correct amount.
• Duplicated and unbundled services: Look for repeated entries of the same service on a single bill or claim. Be cautious of itemized services that should typically be billed together as a package. 4. APPEAL CONCERNING CLAIMS If you suspect your insurance provider has denied a claim due to an error, follow the appeals process. This is specific to each insurance carrier and may involve providing additional documentation and putting together a detailed case for approval. Parents can take this on themselves or use a service that negotiates appeals on their behalf, to save valuable time and avoid countless rounds of phone tag and hours on hold.
• Incorrect dates or details: Ensure the dates of service listed on the bill and claim match the actual dates your child received medical care. Confirm that the billing provider's name and information match the one who treated your child. Finally, make certain insurance and identifying information on bills and claims is correct.

At the end of the day, in the complex world of medical billing, knowledge is any parent’s most powerful tool. By understanding the landscape, recognizing red flags and taking proactive measures, you can protect your most precious asset, your family, from billing mistakes and fraud. This ultimately ensures your children receive the quality care they deserve while still safeguarding your financial resources.•

ABOUT THE AUTHOR:

David Burzynski is a proud dad and the Chief Customer Officer for HealthLock — a leading digital solution that monitors members' healthcare claims and keeps them apprised of possible red flags putting their medical identity and finances at risk. In his role, David ensures HealthLock reaches and meets the needs of millions of everyday people who want more control over healthcare billing and privacy. More at healthlock.com.