Summary to Dealing with Hospital and Health Insurance Bills

Part 2, Chapter 5: Traditional Individual and Group Plans, Hospital Bills Page 11

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Summary

Dealing with hospital bills has become far more complex than it once was. Given the current cost of hospital-based care, it's essential that you understand the rules under which your insurance policy operates and the specific coverage provided by your policy for hospital services. Although many claims for such services are reimbursed routinely, there are also a variety of problems that can occur. Those problems may include

• difficulty in obtaining pre-authorization, or in demonstrating that such pre-authorization was obtained;
• possible errors on hospital bills, or in the way such bills have been filed with the insurer;
• obtaining benefits from your secondary insurer;
• knowing when to pay a hospital bill;
• dealing with a situation in which your insurer has rescinded payment for a hospital bill.

In some cases, problems can be prevented by carefully following the rules of your health insurance policy. If problems do occur, possible solutions include filing a claim appeal with your insurer, or seeking help from your county or state medical society, your state Department of Insurance or Department of Health, appropriate federal agencies, self-help or advocacy groups, a private medical claim-processing company, an attorney, or your state or federal legislative representatives.

Given the amount of money involved in claims for a hospital stay, it's important for consumers to pay close attention to the billing and claim-filing process. Consumers who understand the system and who are aware of the potential difficulties can often deal successfully with any problems that may occur.

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