By Martine G. Brousse (not AI!)
"The Medical Bill Whisperer"™
Patient Advocate, Certified Mediator
AdvimedPro
January 13, 2025
As a billing manager, I heard that question asked 1000s of times.
This sentence too often leads to too many bad surprises and unexpected bills, as what you
mean and what reality really is, can clash and lead to misunderstanding, unmet expectations,
misplaced peace of mind, future forced responsibilities and surprise bills:
That sentence is “ Do you take my insurance?”
A. What patients mean
My experience is that patients understand a “Yes” response as:
· the medical provider is In Network,
· The provider is contracted with my insurance plan,
· Everything will be covered,
· My insurance will make a payment,
· The office and staff are handling dealing with my insurance including any issue that
might arise,
· I am sure to owe the lowest possible liability,
· I can relax and focus on my recovery.
B. What the office means
In the best of world, that would be the case, but unfortunately, I've been on the other side,
and I can tell you that patients expectations too often exceed reality and facts.
1. When the receptionist or anyone at the office answers “yes” to: ”Do you take my
insurance?” it can often mean:
· your insurance card and information are added into our system.
2. It does NOT automatically mean that:
· they accept full and total responsibility for dealing with your insurance,
· that the/all services are covered and payable by your insurance,
· that your insurance will make any payment,
· that the office will accept your insurance allowance as “payment in full”,
· that the provider is contracted or has a specific financial arrangement with your plan,
· that your responsibility is low or zero,
· that the staff is trained, competent, helpful and able to see the process from the time you receive services to billing your insurance, and to it paying as much as possible,
· that any necessary step or issue will be fully handed by the office.
C. There are solution!
Due diligence and a few advance efforts pay off!
Whenever possible:
· Check with your insurance. Go online to confirm that a specific service, treatment,
prescription, surgery, intervention of any kind is a covered benefit, and at what potential cost
· If you have a specific code for that specific procedure, prescription or intervention, a phone representative should be able to let you know whether or not you can expect the item
to be covered and at what rate.
· Keep track of your yearly maximum share of cost (deductibles and maximum co-insurance). How much you have met so far will determine how much you might still be billed for in the future
· Asking too many questions at the office is a must! How will every insurance billing be handled? Do I have to get reimbursed by my insurance or do you bill them directly? Is an authorization needed? And if yes, has it been obtained?
What is the anticipated cost for the procedure, device, prescription or service?
· Stay In Network: lists are available on your online portal or you can directly input your chosen provider’s name to confirm their status with your specific plan. While they may well accept the insurance PPO plans, they could reject your HMO or Marketplace policy.
· Trust the staff to do their job, be competent and supportive… but to a point. Make sure you trust the right person to do the right job that they can actually help you with! Just as the biller would not be able to give you that injection or take your blood, the nurse or doctor may not be knowledgeable to answer any insurance or cost-related questions.
· Get it in writing! Print out what your insurance portal indicates. You never know when you may need it down the line. And if services will be Out Of Network, demand a service itemization, cost estimate and insurance payment verification in writing, especially if asked for an up-front payment or advance deposit.
The healthcare system is a maze of a nightmare, but they are solutions to help you reduce bad surprises, force the maximum out of your insurance plan, help you relax and focus on your recovery. A little time and a little effort can often lead to the best and most positive outcomes for your health… and for your wallet.
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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