What to Do with Mystery Medical Bill

What to Do with Mystery Medical Bill
If you have received a mystery medical bill from a party you don’t know, read on

If you have been injured in an accident, you could receive bills from a number of different parties. If someone you don’t know sends you a mystery medical bill, know what to do.

Understand the Source of the Bill

After an accident, many parties could potentially take part in your medical care. A bill from an unknown source could be the result of:

• An ER visit. If paramedics did not have access to your insurance information at the scene of the accident, they would have taken you to the closest emergency facility. If the hospital where you received care does not qualify for your insurance in-network care, it might issue a bill.
• Hospital specialists. In Colorado, hospital facilities, physicians, specialists and labs typically bill separately. So, for example, if you go to the ER, you will almost always receive a facility bill, a physicians bill, separate bills for any specialists you see, as well as bills for any radiology / imaging, lab work or anesthesia you receive.
• Out-of-network specialists. If your primary doctor referred you to an out-of-network specialist for testing or treatment, you could receive a separate bill from that provider. Physical therapists, MRI techs and others often fall into this category.
• A balance bill. Out-of-network specialists who provide services in an in-network facility might send what’s known as a “balance bill” to charge for the fees not covered by your insurance. In this case, your insurance likely paid part of the bill, but not the entire fee.

Before you write a check to pay any mystery medical bill, first understand who sent it and why. You can call the facility for more information before taking any next steps. Then contact your insurance provider to discuss what you actually owe.

You can also consult with an attorney to determine if the bill is legitimate and if insurance or another party should hold responsibility for the charges.

Colorado Law Protects You

In 2006, Colorado legislators passed Senate Bill 06-213 to protect consumers from balance bills. If you received care at an in-network facility, you should not owe on a balance bill — even if an out-of-network provider performed the care.

However, the law does not prevent providers from sending these type of bills, so people receive them all the time. If you do receive a balance bill, do not automatically write a check.

Other Steps to Take

As you review the medical bills from your accident, take time to understand your rights and responsibilities:

• Review the insurance explanation of benefits (EOB) for each claim or bill. The EOB details who received payment for which treatment — and how much you owe.
• Talk to your insurance provider. If the company rejected your claim or did not pay the full amount, ask them to review the claim again. Mistakes do happen.
• Check your insurance card. If DOI or C-DOI appear on the card, Colorado’s balance billing law should protect you.
• Call the main provider. If you have been billed separately by another party, reach out to the primary provider who managed the treatment. They should know if you have received additional bills. They can also help explain your overall bill.

Finally, consult with an attorney. If you believe you have been treated unfairly by any medical providers or by your insurance company, contact an attorney for a consultation to determine your rights.

If you have been injured in an accident and have questions about insurance coverage and medical bills, contact us. Initial consultations are always free.