Right Choice Index

Page Contents

Common problems

General tips

Special consumer
services

Site Contents

Patients & visitors

Medical professionals

Yale-New Haven
Children's Hospital

Yale-New Haven
Psychiatric Hospital

General information

Calendar

Online resource

Press information

Phone Numbers

Directory assistance
(203) 688-4242

Patient Information
(203) 688-4177

Adult emergency
(203) 688-2222

Children's emergency
(203) 688-3333

Admitting
(203) 688-2221

Children's admitting
(203) 688-3331

Psychiatric admitting
(203) 688-9907


Mailing address:

Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202

How to Prevent and Solve Hospital Billing Problems

Ever had a bad hospital billing experience? If so, did you consider how you could have prevented it or resolved it more easily? The most common causes of billing problems are discussed below with general tips and suggestions for handling each problem.

Common problems

Incorrect Insurance Card: The number one cause of billing problems is an outdated insurance card or not having your insurance card with you when you receive medical services. Health plans change their procedures and issue new cards regularly, employers often change health plans and employees often change jobs. It is very easy to use a wrong, outdated insurance card.

• Prevention: The easiest way to avoid this problem is to always throw away old cards and make sure you have multiple copies of your new card. Keep these copies in your wallet or purse, car, in a file at home and at the office. Always give your physician's office a copy of your latest insurance card for their records.
• Solving the problem: When you receive the first bill, contact the physician's office or hospital to provide the correct insurance information for rebilling.

Failure to obtain pre-certification: Another common cause of billing problems is the failure of the consumer or the physician's office to obtain pre-certification for a procedure or an admission. Most health plans and insurance companies will not pay for services if they do not give approval in advance or within a designated timeframe, usually 24 hours after an emergency situation.

• Prevention: Know your benefits. It is important that patients make sure the doctor's office obtains pre-certification when necessary for hospital visits and for some outpatient procedures. Read both sides of your insurance card. In an emergency, your card may contain valuable information such as a requirement to contact your insurance plan within 24 hours of visiting the emergency department.
• Solving the problem: Call your insurance plan's membership or customer service line to explain the situation. If this is not helpful, ask your doctor's office to call your insurance plan. You could also talk to your company's human resources benefits manager since they purchased the plan.

Failure to provide supplemental or spouse insurance: Make sure you give the provider of your medical services all relevant insurance information. If you are covered by more than one insurance provider, be certain to provide this information. This is particularly true for patients who have Medicare plus a supplemental policy. Sometimes, in addition to primary insurance, a patient is covered by a spouse's insurance or by supplemental insurance. If this information is not disclosed at the time of the visit, the physician or hospital cannot bill against those plans, which might increase the patient's portion of the bill.

• Prevention: Make a list of all your health plan insurance identification numbers and keep them in your wallet or purse. Make sure you give this information to your physician's office and hospital admitting office at the time of service.
• Solving the problem: Contact your hospital or physician's office with your additional insurance information when you receive your first self-pay bill so the provider can complete the insurance billing.

Confusion over multiple bills: During a single hospital experience, you can expect to receive a bill from each provider--such as the emergency department, radiologist, admitting physician, consulting physician and anesthesiologist, as well as the hospital. For example, if you were admitted to the hospital by your primary care doctor you will most likely receive two separate bills, one for hospital services and one from your doctor for referral fees. Also, note that if you see many physicians while in the hospital, each physician who treats you will bill you separately rather than giving you one general hospital bill.

• Prevention: As you receive the bills, a good first step is to clarify where the bills came from and develop a file for each provider.
• Solving the problem: If you receive a bill and do not understand either the reason for the bill or the actual charges, contact the provider of the bill directly so you can request better information. The telephone number can be found on the bill or statement you receive.

Failure to understand benefits: Due to the complexity of managed care, patients often do not understand what procedures and services are covered or what their co-pays are. Also, benefits such as psychiatric or eye care are outsourced frequently and provided by a separate insurance company.

• Prevention: As difficult as it is, consumers need to read and understand their plan benefits. Read your manual and highlight key information. Look for terms such as "medically necessary" and "exclusions." Review anything that is not clear with your benefits department.
• Solving the problem: If you are having difficulty understanding the benefits when you are choosing an insurance plan, you should contact your employer's benefits manager for clarification. If your question is regarding a previous or future medical service, contact your insurance company directly for assistance.

Insurance payment is different than expected: While only a small percentage of claims are paid incorrectly, it does occasionally happen.

• Prevention: Know your benefits. Before a hospital stay or an outpatient procedure, call your insurance company to confirm your benefits. Your insurance representative will be able to give you an estimate of what should be covered. You will then be able to plan for your deductible and out-of-pocket expenses, if any. Again, make sure your physician and hospital have the correct insurance information on file.
• Solving the problem: Keep all records of your bills. Talk to the membership or billing service department of your insurance plan as soon as you notice a problem. If you have been wrongfully denied coverage, you have the right to appeal the insurance plan's decision and they must reply within 90 days.

General tips to prevent billing problems

• Make sure your bill is actually a bill. If carefully checked, what appears to be a bill may actually say: $0 balance due; your commercial carrier has been billed; this is a statement; or this is not a bill. No payment is required at this stage.
• Carefully read every bill or statement from your doctor, insurance company or hospital. Do not assume that your insurance plan will take care of it for you. Call the telephone number on the document with any questions.
• Always get the name and phone number of any insurance/hospital/physician office billing person you talk to. Note the date and time of the conversation. If you are not satisfied, ask to speak with their supervisor. If still not satisfied, go up another level. If still not satisfied, ask for a face-to-face meeting or an appeal of the payment matter. As a last resort, write a letter--insurance companies and HMOs must respond to formal written appeals.
• Sometimes employers fail to pass on their files of new employees eligible for coverage to their insurance carrier/health plan. Make sure you are covered. Check with your benefits manager. If you have recently been hired or changed plans, always double check with your benefits manager.
• Keep all invoices, receipts, billing statements, bills, copies of checks and interactions with billing personnel in chronological order in case you need to refer back.
• Always call immediately if you notice a billing problem or you if do not understand the bill. The sooner you bring it to everyone's attention, the fresher your experience will be with your doctors and hospital and therefore easier to track and resolve.
• Always pay your bill to avoid being turned over for collection. If you cannot afford to pay at the moment, call your hospital or physician and work out a payment plan. Often patients are eligible for state, federal or local funds that cover hospital bills. Many hospitals have some free care funds available, funded by donors, for patients in need of financial assistance.
• Be persistent. There is a window of opportunity to have bills resolved. If you wait too long it becomes harder. If you are not satisfied with answers, keep calling back and schedule face-to-face meetings.
• Contact your state managed care ombudsman program if you are still unsatisfied after repeated attempts to resolve your problems. In Connecticut, the number is 1-866-HMO-4446.

Special consumer billing services for YNHH patients

• When you are admitted to Yale-New Haven Hospital, you are assigned a Patient Account Representative (PAR) who can answer your billing questions while in the hospital and, more importantly, can work with you after dishcarge. Your PAR will make every effort to meet with you in the hospital. Keep his or her number. You can contact Patient Account Representatives at (203) 688-2221.
• The general hospital billing number is (203) 688-2030.
• Call Yale-New Haven Patient Financial and Admitting Services at (203) 688-2046 if you wish to make an evening appointment to talk about billing problems.
• Programs are available to help those in need of financial assistance. Yale-New Haven Hospital can often help you find out if you qualify for federal and state funds to cover your hospital costs. Call the department of social work at (203) 688-2195. The Yale-New Haven fund can be requested at (203) 688-2030. Those without health insurance whose income is at or below two-and-one-half times the poverty level may be eligible for this fund.
• Yale-New Haven Hospital has a patient relations department that helps patients who have nonbilling questions or concerns about their current or past stay. The patient relations department can be reached at (203) 688-3430.
• An example of a Yale-New Haven Hospital bill can be viewed on our Web site. Simply place your mouse over a portion of the bill and a description of that section and an explanation will appear.
• The Yale-New Haven Hospital Web site has a section that gives general information on financial arrangements and billing for Yale-New Haven patients.
• You can E-mail you patient billing questions to patientinquiries@ynhh.org.
• If your question is about a bill from the Yale Medical Group, call (203) 785-4216 or toll-free 800-826-9922.
• If your question is about a bill from Yale Diagnostic Radiology, call 800-996-3395.

Last revised: March 5, 2004 (cfs)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.