Medical Insurance Billing

Posted on July 9, 2023July 9, 2023 by lindameckler9

Medicare ????????????

The time of year for us senior citizens to make decisions on what kind of Medicare do we need.

I would say it would be determined by your income.

I would say it would be determined upon your health.

I would say it would be determined upon your doctor.

Now that you have determined this what is next.

But how do you determine if your doctor is on your Medicare plan.

Call Medicare. The customer service representative can tell you if your doctor is on your plan.

Medicare Plans

Regular Medicare

You pay 80% of your bill and you pay the 20%.

You can have a secondary insurance to cover the 20%.

HMO

This is the cheapest way to go but also the most aggravating.

You must pick a (PCP) a Primary Care Physician.

You must go by referral to a specialist or medical test.

You must have an authorization to have surgery or some specific test.

You must stay inside the contracted arena of medical care for your HMO.

PPO

You have more control over your medical care. But it does cost more.

Medicare/Medical or Medicaid

You need to qualify for this insurance.

It is for low income.

Whatever insurance you decide to go with always check with Medicare to make sure you are up-to-date in their computer system. 1-800-633-4227

www.lindameckler-author-author.com

My books Medicare and Other Health Insurances and Appeal and Collections Letters are available on Amazon.com.

Thank you for reading my article. Linda Meckler 2023 copyrighted

Posted on July 9, 2023July 9, 2023 by lindameckler9

Elementor #1790

Understanding Medical Insurance Contracts

What most people do not understand is the way medical insurance works. In plain English, it works by insurance contracts. The insurance companies are the ones to blame for this big mess in the healthcare system. They make all the money and love to keep their clients confused as to what it is all about. When the knife slices the reality of what it is and what it isn’t paying for it is too late.

A Medical Provider is a doctor, laboratory, hospital, ambulance company, x-ray lab, etc. Each medical provider signs a contract with each individual insurance company they want to be contracted with.

Every contract is different. With a doctor, it would be considerably different than it would be with a hospital.

This contract simply states that the medical provider will accept this insurance or that insurance and receive a percentage of payment.

Now with each insurance company the percentage changes.

Employers: The employers or business owners sign a contract with the insurance companies. This is where it becomes confusing. There are many different plans with the insurance company.

Medicare

Straight Medicare-

You pay 80% of your bill.

You may have a secondary insurance.

HMO – This is where you have a PCP or Primary Care Physician. You need a referral to see a specialist and authorization to have surgery or some sort of test. These medical providers you will be scheduled with are within your medical contract. You pay a copay with each visit.

PPO – This is when you can make your own appointment with a specialist. You pay more for this insurance and you can go out of the contract of medical providers but it will cost more.

Straight Commercial Insurance – This is when you pay your contracted rate and a percentage of what your insurance doesn’t cover.

This is why when patient A goes to Dr. Brown and has a general examination of blood pressure and a blood test. The insurance will pay a certain percentage and the patient will be charged the rest after something has been adjusted off per the contracted rate.

Patient B same thing, the same doctor. But when patient B receives his Explanation of Benefits (EOB) from insurance the rate the patient is expected to pay is different.

This is because of the name of the insurance company and the type of plan that was picked.

FOR MEDICAL PROVIDERS

My book Appeal and Collection Letters is for you.

If you have any questions please contact me on my website www.lindameckler-author-artist.com

Linda Meckler author of over 25 books and worked in Medical Insurance Billing for over 25 years. Her book Medicare and Other Health Insurances. Explains in simple English how Medical Insurance Works, sample Appeal Letters, and much more.

Posted on April 19, 2023April 19, 2023 by lindameckler9

Social Security What A Joke

What do you think seniors? Can you live on the amount of money you get from Social Security monthly?

The amount of Social Security stays the same. But everything else goes up.

Food has gone up so high in price I don’t want to go into the grocery store unless I have no choice.

People have to eat to stay alive.

They need a home. Whatever that means to you.

They need medical care.

They need dental care.

They need clothes.

They need to be clean.

This sounds so ordinary but is it.

Today thousands live on the streets. All these necessities evaporate in their search to stay alive.

Politicians who are running for office love to mouth off about cutting Social Security and Medicare.

Keep it up and you won’t get elected.

There are more living (voting) seniors alive than ever before.

Thank you for reading my article.

Posted on June 21, 2022June 21, 2022 by lindameckler9

Medicare HMO Horrors

www.lindameckler-author-artist.com

I have worked in medical insurance billing for almost thirty years. I have said repeatedly that the insurance companies practice medicine.

In an article in the AARP June Bulletin 2022, there is an article that does indeed prove what I have said.

This article states that when Medical Providers see their patients and require pre-authorization for testing, or surgery Medicare denies it.

Federal Investigators reviewed a week of these inquiries in 2019 and found that those denied 13% should have been authorized under the original Medicare rules. 85,000 requests that year were wrongfully denied.

What about the years before and after 2019?

Do not take for granted when something is denied that is denied permanently.

A medical appeal can always be sent to Medicare. If a medical provider requests pre-authorization for a test, surgery, etc. that means the patient needs it. If the patient does not receive the care needed, you can use your imagination as to the result.

Thank you for reading my article. My books Medicare and Other Health Insurance and Appeal and Collection Letters for Medical Providers are on www.amazon.com

Posted on December 21, 2021December 21, 2021 by lindameckler9

Drug Check

When you are picking up your drugs from the pharmacy these are the things you should check before you take them home. This could be a life or death drug mistake.

Make sure your name is spelled correctly. There are many people with the same name or others with similar names.

Check the date of birth on the bottle. Is it yours?

Check the name of the drug. Is this what you take?

Check the amount of the pills in the bottle. Is it correct?

Check to see if the refills have been applied to your drug.

Yes, the label is computer generated but humans put the information into the computer and humans make mistakes.

In most cases, your prescription is emailed to your pharmacy without anyone having to read the doctor’s handwriting. But there are still handwritten prescriptions and the person reading it could read it wrong.

BE AWARE.

Thank you for reading my article.

Posted on November 16, 2021November 16, 2021 by lindameckler9

Medicare Blunders For You To Prevent

If you have Medicare the way to find out if you are going to be charged for a procedure or for anything you use your medical insurance for is read this.

First of all, your doctor prescribes some type of procedure for you to have either in his office or at an outpatient surgery center. The doctor’s office receives the authorization for you to have this procedure.

What is it going to cost you?

You think because you have an HMO or other type of insurance that it will be covered.

Don’t assume anything.

The only way to find out for sure is to get the CPT and ICD codes from your doctor’s office and call your insurance company. In this way, you should have an accurate amount that will be billed to you or it might not be exact but you will have an idea.

When the procedure is over and the bills come in you won’t stress over the copay that was the patient’s responsibility.

All this information is in my book Medicare and Other Health Insurances.

Thank you for reading my article. Copyright Linda Meckler 2021

Posted on November 16, 2021November 16, 2021 by lindameckler9

Medicare Is Tricky

Why is there mass confusion when it comes to Medicare? Even when you think you have a handle on it and understand your Medicare plan it can backfire on you.

I needed to go to the emergency room a few months ago for a minor problem with slivers of wood in my foot, but I needed to have this visit. The doctor spent ten minutes with me and I was fine.

I expected an emergency room copay of $85.00. That was supposed to be the only charge.

I received the bill and didn’t think anything about it. Then I received a bill for over a thousand dollars. What was this bill for?

This bill was for the physician’s bill which was sent from a separate billing service. I began to hyperventilate. The date of service which is what is the most important thing on the bill was missing. I called the phone number and found out the bill had never been billed to my medical insurance they didn’t have that information.

If you have read my book Medicare and Other Health Insurances it talks about this. After being on hold forever both at the billing company and my insurance company the bill will be sent to my medical insurance. But are they going to pay all of it? Will there be a co-pay left for me to pay?

When I talked to my medical insurance, I asked the question of why this bill when I was only supposed to pay for the ER visit.

I thought it was an error.
I thought I might have gone to a hospital that was not contracted to with my medical insurance. (I was told that I could go to any hospital for an ER visit. If admitted I needed to go to a specific hospital.)

When I asked my insurance company If this hospital was contracted with them? I didn’t get an answer. I will have to wait and see if it is paid or denied on my explanation of benefits and for what reason.

3. They didn’t have my medical insurance information.

Posted on October 8, 2021October 8, 2021 by lindameckler9

Medicare and Other Insurance Plans

Do you understand Medicare?

If you have Medicare, do you understand it?

Do you understand how Medicare works?

Do you know what parts A, B, C, and D mean?

If you do not understand this you do not understand Medicare.

Medicare is complicated.

I don’t know why it is this way.

Do you?

Maybe it could be simplified.

Maybe it could be easier to understand.

What do you think?

What do you not understand?

Thank you for reading my article.

Posted on October 8, 2021October 8, 2021 by lindameckler9

Red Hot Medical Bills

Believe it or not, you are not the only one who has medical bills. They seem endless and never-ending. You can get them from medical providers you have never heard of or thought of. Where did all these bills come from? If you have been in the hospital for a long-term stay expect a huge bill.

First, you have to break it down. What Date of Service (DOS) was billed and what was paid and what wasn’t paid and why – line by line.?

Let’s break it down. When you are admitted to the hospital for a scheduled surgery there is a facility fee. The doctors which are treating you have their fees. When tests are performed such as x-ray, MRI’s, lab, or any medication there are fees for these.

While in surgery there is an assistant surgeon and last but not least the Anthologist. These are all the normal fees but of course, there could be other fees for your special needs.

Wow! these fees add up and your bill could be at least 30 pages long. When you have medical insurance your insurance company is billed. The insurance company whatever it is will usually pay 80% of the allowable. The allowable is determined from the contract your medical provider (the hospital) has with your insurance company. This is written off in a contractual agreement. It can be a different amount for different insurance plans. After the insurance has paid you are billed the balance of the bill if you do not have a 2^nd insurance to apply it to.

If you have 10 bills from different Medical Providers this can get confusing and expensive.

Medical Bills are billed from the Date of Service (DOS) you were seen by a Medical Provider or in patient in a Hospital, etc.

There are all kinds of problems that can crop up which your medical insurance company will bring to your attention. This is where medical appeals come in.

Also, you must have some kind of understanding of how your insurance company works if you want to protect yourself and your family.

Now with people entering hospitals and are there for long or longer stays the medical bills are going to be astronomical.

Now you have to look at every Explanation of Benefits (EOB) line by line.

You have to make sure everything was billed from each individual medical provider.

This is going to be complicated.

My book Medicare and Other Health Insurances will help you understand what the next step will be needed to get your bills paid.

Thank you for reading my article. Please feel free to read any of my numerous articles on various subjects.

Posted on August 23, 2021August 23, 2021 by lindameckler9

Holding Public Office President Biden

Holding Public Office

I would not want to be the President of the United States. There is so much chaos going on in the world and in the United States. Every time a discussion or decision has to be made on some huge problem there are too many ideas to solve that particular problem.

How does anything get done?

Look at Afghanistan President Biden decided to pull the troops out of that country and look what happened. All hell broke loose.

Who is right and who is wrong?

If you listen to this news station the president is right.

If you listen to another news station the president is wrong.

The buck stops with the president and I would not want to be in his shoes at this time In history.

The world is complicated and it gets more complicated each day. I hope the people, our elected officials, can stop bickering like toddlers and help the president make the correct decisions to keep our great country great.

Thank you for reading my article.

Linda Meckler