This is definitely a time of uncertainty. While we stay quarantined at home due to the Coronavirus, a number of us furloughed or out of work, there is a lot of financial concerns. Let’s not let medical bills be another stressor. This is the very dry, somewhat overly detailed facts about the Coronavirus and medical insurance that you need to know.
Our hope is everyone avoid illness and/or recovery quickly; however, we already know this may be unavoidable due to the aggressive progression of the disease. As a result of illness, you will have medical bills. There is good news! Most of the medical costs to treat the Coronavirus (COVID-19) should be covered by your medical insurance. In blunt terms, you pay $0 or another low dollar amount.
There will be INACCURATE denials. You will be billed for services that should be covered. Basically, check your bills!
You need to take an active role in this process. Nothing is perfect. Sorry, it is true. Honestly, 4 out of 5 medical bills contain errors. You imagined that ever bill you receive is accurate… nope. Every single time, I receive my internet and cell phone bills there is always something wrong, a new tax, extra charge, and the list goes on. The same is true with healthcare. Medical error is inevitable. You just need to know how to quickly review and avoid.
In my book, Healthcare Deciphered, this is the focus. A quick detailed guide on medical insurance. There are plenty of tips and tricks to ease the pain of reviewing medical. It is important, I assure you.
Check your medical bills, invoices, and most importantly your eligibility (EOB) statements from your medical insurance. If there is a considerably high bill, don’t pay it until you investigate. Especially, if it is linked to the Coronavirus!
I’m providing insight below on a few topics all related to medical claim processing starting with your physician or hospital, going through your medical insurance, then to your for remaining payments. You need to know what to expect. STOP OVERPAYING FOR CARE
- What is a Coronavirus Diagnosis Code?
- Why does this matter?
- How does this impacts you?
- How do you find errors?
- What to look for before I pay anything?
- How to get any errors corrected?
I know, I know, I know reviewing the massive amount of documentation from your medical insurance is absolutely boring. Yes, it’s weird I generally enjoy it and have a passion for this field.
What is a Coronavirus Diagnosis code?
There is no specific diagnosis for Coronavirus, at least not yet. The diagnosis is related to your overall symptoms. Therefore, the following diagnosis should be used when you have the following conditions:
- Do you have acute bronchitis confirmed as due to COVID-19 utilize diagnosis code J20.8
- For Acute bronchitis due to other specified organisms or not specified as acute or chronic due to the COVID-19 use B97.29
- Are you experiencing Bronchitis not otherwise specified (NOS) due to the COVID-19 use J40
- Do you have a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS use code J22
- For acute bronchitis due to COVID-19, use J20.8
Sorry, the above is very detailed. There is a number of reasons having the right diagnosis code matter.
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Why does this matter?
The short answer you get better more affordable care! That is certainly the short answer. For those, who like more details let me explain how this works.
- Costshares are lower or zero – Costshares include your copayment, deductible, and overall remaining balance that you pay for care. For example, when you go to the physician’s office, your doctor usually charges a copay, maybe $30 a visit. This is your financial responsibility. As part of the Coronavirus to motivate you and your family to get care, Coronavirus tests are at no cost to you. Yes, you pay absolutely nothing ($0). Also, for care that includes a Coronavirus diagnosis code, most plans are paying 100% of the cost of care. Make sure your doctor includes the correct diagnosis codes, otherwise, you will end up paying more out of your own pocket, then is really necessary.
If you have more questions on costshares, check out Premium vs. Deductible for more information on medical insurance.
- Most insurances right now are starting to waive or relax authorization requirements as part of the pandemic. Typically, insurance companies have medical necessity requirements for oxygen, nebulizer, and other respiratory services. These types of services are the primary treatment for the Coronavirus, along with antibiotics. This could differ depending on your physician’s recommendations. I am not a physician. My background is specifically related to the administrative side of healthcare, basically the part no one really understands. I completely understand how it works operation
ally. In order to provide care to you faster, administratively there will be errors. It’s an accident, not intentional, but it happens.
How does this impact you?
Medical insurance companies, hospital, physicians, and the government are doing everything in their power to help control and prevent further spread of this pandemic. The healthcare community is being creative to open up more beds, cancel elective procedures, auto-approve services related to the treatment of the Coronavirus, and expanding the use of telehealth.
The expansion of telehealth services is huge! As an industry, we’ve been trying to move into this practice more. Unfortunately, until this pandemic started the growth in this area was slow. Now most medical insurance companies have expanded the types of providers who can use telehealth for visits. There is no need for you to go into the office, your physician should be able to diagnosis your condition over the computer or phone. You get to stay at home, the physician gets paid by the medical insurance company for the visit. It is a win-win. The only drawback is if additional tests are necessary to diagnosis, eventually you will need to visit an office in person.
You are even able to get your supplies or prescriptions sooner. Medicare has the most expanded coverage under the Coronavirus, as hospitalization coverage is fully covered with a Coronavirus diagnosis.
What to look for before I pay anything?
There is a considerable amount of change happening to assist with Coronavirus patients. In addition, to changing the way we provide care to patients, we are modifying the operational and administrative side of healthcare. The part of healthcare that gives most people a headache and is nearly impossible to understand with out a degree in healthcare. Luckily, for you, I have a master’s in healthcare.
Anytime, there are major changes to the way claims are processed, this usually results in an increase in denials. Denials mean you pay more money. That is certainly not the end goal.
A denial means the medical insurance does not believe their responsible to pay for your care. Mostly, this is the result of medical billing error or non-covered benefits. Good news, all services for the Coronavirus are covered services.
Just make sure to catch the errors. For example, emergent vs non-emergent services are very different. Did you receive a high bill from the emergency room? Please call your insurance company to see if it was billed as emergent or non-emergent. If it was billed as non-emergent, time to call the hospital to get the claim corrected. Most people have coverage for emergency services, so make sure not to overpay.
How to get any errors corrected?
Did you find an issue? The first step is to call your medical insurance to get the details on the claim. Your claim should be a representation of your services, from the type of visit, diagnosis code, and overall experience. If something is different, it is probably wrong. If there is an error, you are paying more then necessary.
Here is a HUGE suggestion. While you are on the phone with the medical insurance company, ask for your claim to be re-processed. Yes, you have the power, use it! If there is an issue, simply ask for a claims processor to re-look (re-adjudicate) the claim. This takes about 30 days but is totally worth it. There is no reason to overpay. Medical bill is the primary cause of debt in the U.S. If you still have questions, check out the below articles.
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