What Your Medical Bills Mean in Plain English

One of the most frustrating parts of any personal injury case is trying to make sense of your medical bills. It often seems as if the bills were purposely made hard to understand just to frustrate you. Much of the reason for the complexity of medical bills has to do with the way insurance companies evaluate and pay medical claims – and nothing to do with the individual patient.

It is important for an experienced Memphis personal injury lawyer to understand the medical bills. The amounts of the bills do more than just indicate how much doctors, hospitals, and other health providers are owed. Medical bills are often used as an indicator of how much the pain and suffering part of your claim is worth.

The Tennessean recently analyzed the various parts of medical bills. Many medical bills are inaccurate. According to the news article, nearly 4 in 5 bills have some error. These errors can cost the patient money.

The explanation of benefits letter

Patients normally receive at least two documents. The first is called an Explanation of Benefits (EOB). The second is the itemized medical bill. Typically, the patient is sent the EOB first. Your own insurance company sends the EOB.

The key parts of an EOB letter are:

• The EOB reviews which services were performed on specific dates
• It can include how much the doctor or hospital charged for the medical service
• It may show how much the insurance company paid
• It likely also shows how much you owe – basically, what the doctors charged minus what the insurance company paid

The EOB document should say that the document is not a bill. It is a document you/your lawyer will compare against the actual bill when the bill is sent.

The bill usually matches what the EOB says. It instructs the patient how much is owed and how and when the bill should be paid. The word “match” doesn’t mean the bill will be itemized. It’s often just the net result. Patients who want an itemized bill should ask their health provider for the itemized bill.

Itemized bills can be confusing too. The itemizations are usually based on codes. Doctors and other healthcare professionals generally use codes for each type of service – diagnostic, treatment, or otherwise. The codes are typically set up by the insurance company or a payer like Medicare. The codes are easy for computers to understand but hard for humans to comprehend.

Patients who don’t understand the billing codes can call the billing department. Your lawyer may call on your behalf.

The amount charged for each service can also seem mysterious. It’s often likely that the physician will charge a high fee for a service, the insurance company will only agree to pay a smaller fee, and the doctor will then accept the smaller fee.

Patients should also understand that in personal injury cases, payment to physicians is often delayed. Many doctors agree to defer payment for services until the case settles or until there’s a jury verdict. The trade-off is that the doctors and hospitals are paid off the top before the patient gets his or her share.

Medical bills are a key part of every accident case. They show what services you received, which doctors or health providers you saw, and how often you saw them. The personal injury attorneys at Bailey & Greer, PLLC, work with your doctors to understand and document your injuries. In some cases, our Memphis, Jackson, and West Tennessee trial lawyers recommend you see other doctors. Call us today at 901-680-9777 or fill out our contact form to make an appointment with our experienced team.