By Martine G. Brousse (not AI!)
"The Medical Bill Whisperer"™
Patient Advocate, Certified Mediator
AdvimedPro
March 4, 2025
There are medical mistakes and medical errors. Some lead to detrimental health outcomes and even deaths - errors are now the 3rd leading cause of death in the US – and can be considered “malpractice”. Examples are failure to consider drug interaction or allergies, administrating the wrong Rx or dose, misdiagnosing a condition, doing surgery on the wrong body part, practicing outside of the scope of practice over license or training, failure to understand or look at test results, premature discharges and more.
This blog focuses on lesser mistakes, which may not affect your wellbeing negatively, but can certainly cost you money. How to recognize and avoid them? Let’s explore.
A. Common types of (lesser) Medical Mistakes
1. Miscommunication between healthcare providers
· They don't know of each other
· They don't talk to each other
· There is no transfer of or incomplete transfer of medical records
· Updates are not communicated and/or treatments are not coordinated
· There is little or no sharing of each other's clinical data or test results
These missteps often lead to duplication of labs or tests or unnecessary services. Those cost you money.
2. Miscommunication between patient and a medical provider
· Misinterpretation of instructions, especially due to language barrier, fear to ask or rushed advice by an hurried provider
· Failing to share your medical history, family history, current treatment with another physician, or other clinical data, such as test/scan results or lab reports when originating through services rendered by another clinician
· Thinking “it would not matter” or “it’s not important” as the reason not to share clinical info
These missteps often lead to duplication of labs or tests or unnecessary services, or even unnecessary treatments and side effects. Those cost you money.
3. Miscommunication with the Office or Billing Service
· Failure to communicate update or new insurance information, or demographic data (new address, married name..) can lead to denied authorizations and non-payment by your insurance. You might end up financially responsible for the full amount billed.
4. Staff issues
Inadequate, incompetent, overwhelmed or badly trained billing staff can:
· fail to obtain a necessary authorization,
· fail to respond to an insurance request for records or information,
· miscode services,
· give you incorrect cost estimations,
· forgo confirming insurance benefits or coverage before the facts,
· fail to follow up on or address denied, delayed or missing claims
Non payments by insurance will likely come to you as added or even full cost for billed services.
B. What should you do?
1. Communication is key
Remember to:
· share contact details for all your treating physicians,
· report changes in prescriptions,
· advise on an upcoming intervention or surgery, even if deemed clinically unimportant (cosmetic for example)
· report an unplanned treatment or event such as an ER visit,
· mention any failed or unsafe prescription or side effect,
· share new labs, test results or reports,
· keep updating and sharing a list of all physicians with whom you are seeking or receiving some form of treatment or care as well as the reasons for the visits, any planned or recommended treatment, test or labs reports or other clinical data
· keep a list of diagnoses up to date
· Keep your Rx list up to date.
2. Get a PCP (primary care physician)
· Serves as hub for all medical records
· Keeps up to date record of diagnoses and prescriptions, whether ordered by that PCP or by any other physician supervising a portion of your medical care
· If available, take advantage of any EMR or EHR system to organize lists of Rx, appointments, records. Updates are very easy on such systems as is written communication with your doctors.
Your PCP can flag orders for duplicate tests, labs or scans, saving you unnecessary costs.
3. Keep on top of things ... and ask!
· If a test, lab or scan seems a repeat, or is ordered in a short amount of time after a previous one, ask your physician. They may not be aware of a recent report, or that another physician already ordered it.
· Any service that sounds expensive – such as a genetic lab or scan – should be discussed with the staff. Is an authorization required? Is it a covered benefit? If not, what is the cost estimate? Ask the physician for an alternative that might be payable by my policy.
· Look out for any insurance inquiry. For example, do you have other insurance coverage or what were the circumstances for that ER visit? A quick response will avoid delays in payment or denials.
· Audit any Explanation Of Benefit from your insurance that explains how a charge or a claim from a medical professional was processed and hopefully paid. If something shows as rejected or denied, it's a red flag. Call your insurance for clarification.
· Make sure that your medical bills are correct before paying them, especially if the balance shown does not match the amount due per your Explanation Of Benefits. In that case, a call to the billing department is in order.
As a rule, better waste some time on a call to an insurance or billing office than overpay.
Your financial freedom cannot start until you stop paying for things when you should not.
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
(424) 999 4705 - F (424) 226 1330
@martine brousse 2025 @ the medical bill whisperer 2025™
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