Welcome to a better understanding of the first step in the processing of your medical bill.

The information Below is the information On Your Claim Form.

This information is then submitted to your insurance company by mail or electronically.

This claim form has been sent by your provider, Example: Hospital, doctor's office, x-ray or laboratory.

(1) The Patient's name.

(2) The Patient's date of birth. (DOB)

(3) Date of service (DOS) The day you were seen.

(4) The patient's identification number (the number on your insurance card.)

(5) The name of the Guarantor (name of person insured). Example: Spouse

(6) All doctors have a computer identification number.

(7) All facilities have a computer identification number.

Example: Hospital, doctor's office.

(8) The reason for your visit. Example: Doctor's visit, which will have its own independent (CPT code.

Each procedure the doctor performs has its own separate CPT code.

Each CPT code has a dollar value assigned.

(9) Your diagnosis is assigned a (ICD code.) If you have three different problems each will be assigned a separate ICD code.

(10) The contractual (dollar amount) adjustment your doctor or facility has established with your insurance company.

It means, that less money for you to pay in the long run.

(11) Place of Service (POS) This is where you were seen. Example: A doctor's office, hospital, or laboratory.

(12) The referral number is assigned to you for your medical visit by the insurance company.

This number or referral paper allows you to be seen by your doctor.

(13) The authorization number is assigned to you to receive treatment.

Example: An x-ray. It's a number or paper from your insurance company for you to receive treatment.

(14) If medical records are needed by the insurance company they are attached to the paper claim.

(15) The name and address of your medical insurance company.

What do you do when you receive your Explanation of Benefits from your Medical Insurance Company? (EOB)

The insurance companies love to send the doctor's office or facility complicated Explanation of Benefits. You, as their client, receive the same copy.

WHAT CAN GO WRONG WHEN YOUR CLAIM FORM IS SUBMITTED FOR PAYMENT!

(1) Everything

(2) Your claim form may never get to the correct insurance company.

There are many addresses attached to each insurance company.

The chances of yours submitted to the correct address is rare.

(3) Your personal information may have been entered into the computer incorrectly.

That is why when you call the insurance company and you hear say, "we never received the claim form from your medical facility", it is probably true.

FIGHT BACK:

If you have not received an Explanation of Benefits from your Insurance Company within 2 months of your date of service - CALL THEM!

INFORMATION NEEDED:

(1) Your name and the patient's name.

(2) Your Identification Number

(3) The date of service (DOS)

(4) The name of the facility or doctor where you were seen.

With this information your insurance company can give you the history of your bill.

With this information in hand you can then call your doctor's office and have them intercede in your behalf.

Your claim can always be appealed by the doctor's office and by yourself.

Your claim can always be rebilled if necessary.

YOUR RESPONSIBILITY:

(1) co pays

(2) non covered services

(3) deductibles

All these are listed on your Explanation of Benefits. This is the way your insurance company pays your claim without any money changing hands.

Keep all your Explanation of Benefits. Do not be afraid to call your insurance company.

If you feel you do not get an adequate explanation ask to speak with the supervisor.

The insurance companies rely on untrained people in medical facilities to prepare and submit your claim form. The insurance companies hope the Explanation of benefits will be accepted at face value and never challenged.

PATIENT CONFIDENTIALLY:

Be aware of all the changes pertaining to the laws of patient confidentially.

(1) You can't call a medical facility and expect answers if you are calling about anyone other than yourself, spouse, or minor child.

(2) If you need information about your parents or friend, you need a letter signed by that person filed in the providers office.

Congratulate yourself, you have mastered some words in Medical Insurance Billing.

A little bit of knowledge goes a long way.

Please let me know if this article is easy to understand. This is a complicated issue which can lead to you blood pressure rising and steam coming out of your ears.

If you have any questions ASK. Let me hear your horror stories. Just post a comment on this article. Feel free to read my other articles.

Copyright 2005 Linda Meckler

REMEMBER: EVERYBODY IS ENTITLED TO MEDICAL CARE. NOT JUST A FEW.