Even with health insurance, many consumers have inadequate coverage for major medical circumstances. A prime example is a trip to the ER. Too often, insurers take advantage of confusion about what constitutes a ‘true medical emergency.’ Insurers ask the provider to send information ‘proving’ the emergency nature of care. For reference, many experts consider care provided to an immobilized patient to be emergency care. That would cover things like spinal fractures, respiratory failure, cardiac arrest, or any kind of condition where a patient wouldn't be expected to choose between providers in different locations. It’s important that you understand what constitutes emergency care and that you pressure the provider to make sure this proof is succinctly communicated to the insurance company.
The grievance processes built into the typical health insurance contract are made for the kinds of situations where insurers deny claims based on lack of timeliness. In most cases, situations beyond the patient’s control led to the lack of timely filing. Many of these can be traced back to the provider. However, without good advocacy and even legal representation in many cases, the patient is unable to successfully challenge the provider on this issue.
While the American health care system continues to undergo changes when it comes to medical billing and collection practices, you can improve your own situation by understanding these issues and working them out with provider representatives at the time of care, rather than months later. Just as your doctor has a responsibility to deliver quality care, you have a responsibility to fulfill your requirements relating to financial responsibility. Address bills and requests for additional information or explanation immediately. Manage your provider to ensure that requested documents or details are sent. Many financial consent forms today are very specific about when an open balance will become the patient's obligation. Expediting timelines is extremely important in successfully closing medical bill accounts and avoiding the kinds of situations where credit agencies, attorneys and others have to get involved.