Have you ever gotten a bill in the mail from Big Sandy Medical Center (BSMC) or another medical facility and thought to yourself, ‘what in the world does this mean?’ Chances are, you have probably had a thought similar more than once. The medical billing system in American healthcare is confusing from the beginning to the end of the process, but that doesn’t mean it should be totally foreign to you. The billing department at BSMC has been working hard in the last few years to streamline the process, prevent errors, and make it easier for the patients to understand. It is a constant work in progress.
One of the challenges that all healthcare facilities face is the reality that service is provided long before the patient has an opportunity to make a payment. A mechanic can require payment before returning your vehicle. A photographer can not release images to a client until payment has been received. The electric company can turn off your electricity until you are caught up on your payments. But in medicine, a patient is treated without question, in good faith they (and/or their insurance) will pay for the service later.
The system may never be perfect as a whole, but the billing office does receive the same types of questions frequently that have little to do with the individual bill or service itself, but more of a lack of understanding of the process. To help clarify some of those things, we’ll discuss them below.
Often there are questions about how long to expect before a bill, also known as a statement, should arrive. One would think it would be as easy as ringing up your groceries at the store. That would certainly simplify the process. But, between private insurances and Medicare/Medicaid there is a lot more to it than that. Everything that happens, from the time you arrive to the amount of time the provider is with you, to the size of the IV needle that is used must be documented. Providers may not always have the time to complete their documentation every day. The top priority is always taking care of the patient, so often the paperwork side of the care provided takes a back burner. When they do complete their records, then that visit can move to the next step; coding. Every service provided has to have a code attached to it. If that code is deemed not applicable to your situation by your insurance company, they will not pay for the service. There are over 11,000 codes; 24 of them could be used to list a Chest X-ray. If insurance doesn’t agree with the code that was chosen to classify your X-ray, they may agree with one of the other 23. You can see how this can become confusing and time consuming real quick, so BSMC works with a billing and coding team that takes care of this process for us. After everything is coded appropriately, then the account is submitted to your insurance. Your insurance company reviews the chart and your coverage, then decides what will be paid. Then we receive payment from your insurance, also known as an adjustment. Your Explanation of Benefits can help you understand what payment was made and why. After that adjustment is received and applied to your account, then the remainder of the bill is sent to you. Provided we have the correct mailing address on file. The whole process can easily take two to three months.
After you receive your bill, you may immediately wonder where to find a coupon to help reduce that cost. While it would be nice to have such a luxury, there is an option to help save money! It’s called the prompt pay discount. If you can pay your bill in full within 30 days of receiving the statement, you can receive a discount! There is also a charity care sliding scale fee service that is available to you for those who may need extra assistance. Further information on that program can be found on our website at http://www.bsmc.org/business-financial.
You might also wonder why you receive a bill from Billings Clinic for lab work you had collected here in Big Sandy. While the lab here is capable of running a large variety of tests, they do not have all of the equipment necessary to complete every test ever ordered. The ones that the BSMC lab is not capable of completing are sent to Billings Clinic to be completed. Anything they complete for you is billed through them. So you may have a bill from BSMC for your visit with the provider and a portion of your lab work, and then another one from Billings Clinic for the lab tests they completed.
Finally, how do you make a payment? Cash, check, or money order can be sent to the hospital with the designated portion of your billing statement. There is also a space to enter your card information on that portion of the statement. If you’re in the area you can drop by and issue your payment in person. And if you’d rather save a stamp and a trip, you are always welcome to make payments through your patient portal.
If you have questions, please call up to the facility, explore the website, or come in and visit with Paula or Brittany regarding your bill. It is certainly a daunting process on our end, as well as yours. The staff are here to help, offer clarity, and continue to make progress towards a streamlined billing process.
