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How to be your own healthcare consumer advocate
1. How To Be Your Own
Healthcare Consumer
Advocate
Courtesy of:
Montana Medical Bill Review
2. Overview: Medical Billing
Process
Consumer (patient) goes to doctor, hospital,
or other provider for prevention or treatment
Data collection
Services rendered and documented
Billing document generated using collected
data and codes from patient’s medical
record
Electronic claim form submitted by provider
to insurance company (If no insurance,
payment collected from patient.)
Provider receives payment from insurer in 30
days
3. Anatomy of a Medical Bill
Doctor’s Office Visit
Hospital
Physician Service – Inpatient
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11. Top 10 Things You Can Do to Help
Find Billing Errors
Check Name
Check DOB
Check Account Number
Check SSN
Check New Patient vs. Established Patient
Request a detail bill
Check type and number of procedures (X-rays, lab tests,
EKG,etc.)
Hospital bill – check inpatient vs. outpatient
status/number of days
Check room rate – Private vs. SemiPrivate/ICU, etc.
Check type and amount of medications
12. Working with Provider or Insurance Company to Correct Errors
Collect all your information (bills, account statements, EOB, cancelled
checks, credit card statement, insurance policy number,etc.) and have it
available to refer to, before you contact provider or insurance company
customer service
Remain calm
Smile when you talk on the phone
Provide necessary information to verify your identity and account number
Briefly state your issue/concern/questions
Ask for clarification of any charges or insurance payment denials
Specifically identify billing errors
Request a corrected bill
If necessary, use the appeals process outlined in your insurance policy to
appeal a claim denial you believe is in error
Follow up: review account statement from provider to confirm corrections;
review subsequent EOB from insurance company to confirm claim
status/payment