The bill while you appeal

Treat the Explanation of Benefits as a statement, not a billIt shows what the plan decided and is not a request for payment, so wait for the final claim decision before paying.Ask the provider's billing office to hold the account while you appealThe billing office decides when a bill moves to collections, so ask for a hold and write down the name of the person and the date.Ask when the account would be sent to collectionsKnowing the date tells you how long you have to get the hold in writing or to arrange a payment plan.Tell your doctor's office you are appealingHospitals often appeal medical necessity denials themselves because they want to be paid, so the office may be willing to help.

Ask for an itemized billUnder the Health Insurance Portability and Accountability Act you have a right to your provider's billing records, and the provider must act on your request within 30 days.Compare the bill with the Explanation of Benefits line by lineCheck the amount your plan says is your responsibility against what the provider is charging you.Ask your plan for the diagnosis and treatment codes and compare them with the billA coding error is for the provider's billing office to correct and resend, and a plan that is not grandfathered must give you the codes on request.If the bill is for out-of-network care you did not choose, check surprise-billing protectionsIn many emergencies and at in-network facilities you can be billed only in-network cost sharing.

Ask the hospital for its financial assistance policy and apply nowHospital financial assistance (also called charity care) can reduce or erase a bill whatever your appeal decides, and most patients have to apply.Find the application deadline in the hospital's policyDeadlines are set by each hospital, so read the policy or ask the financial counselor instead of assuming.Ask for a self-pay discount or a payment plan if the bill standsIf the appeal fails and the bill remains, negotiating a discount or a plan is a common next step.

Keep a log of every call with the billing officeWrite down the date, time, name and what was promised, since a hold or a promise to write off is only as good as your record of it.Keep a copy of every payment and every collection letterA dated copy shows what you paid and when any collection notice arrived.Call your state consumer assistance program or insurance departmentA state consumer assistance program can help you appeal, and your insurance department takes complaints about insured plans.Ask a free patient advocate for help with the billThe Patient Advocate Foundation offers free case management by phone at 1-800-532-5274, Monday to Friday, 8:30 AM to 5:00 PM Eastern.

The bill while you appeal

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