Navigating the medical billing maze

Medical care is a fundamental aspect of our lives, but no one wants to deal with the stress of navigating complex and bewildering medical billing processes. According to a recent study by Cedar, 56% of consumers find the medical billing process to be a significant source of stress and 71% find the act of reconciling a billing problem to be equally, if not more, daunting.¹ However, with the right tools and resources, you can navigate this maze with confidence and gain strategies that could help you better manage your healthcare finances.

Why are medical bills so complicated?

Medical billing is often confusing for patients because there are multiple parties involved in providing and paying for services. It can be challenging to understand how your insurance coverage, deductibles, coinsurance, and copayments work in the midst of even a routine health situation, not to mention a medical emergency. Medical billing practices can vary widely between healthcare providers, and often contain codes and terminology that may not be familiar to patients. Once a patient is able to understand their bill, they may also confront billing errors. These kinds of mistakes or inconsistencies may happen, and unfortunately identifying and rectifying these errors can make increase the burden.

Five tips to help navigate medical billing

1. Review your Explanation of Benefits (EOB)

Your EOB is a statement from your insurance company that outlines the services provided, what a provider may charge, the amount billed, and any payments made on your behalf. Insurance companies will either email or mail these. You can also often find them on your provider’s online portal. Reviewing your EOB can help you understand what services were covered and what you may owe.

2. Ask questions

Don’t hesitate to ask questions if you’re unsure about a charge or billing statement. Reach out to your healthcare provider or insurance company for clarification on any discrepancies or unfamiliar terms.

3. Utilize patient portals

Many healthcare providers offer online patient portals where you can access your medical records, billing statements, and insurance information. These portals provide a convenient way to track your healthcare expenses and communicate with your healthcare team.

4. Healthcare advocacy services

Consider enlisting the help of healthcare advocacy services or medical billing advocates who specialize in navigating the complexities of medical billing. If you are a MASA member and experience a medical emergency, our Member Services team will help you coordinate communications to health insurers, verify policy enrollment, confirm medical benefits coverage, and provide a medical expense outline. We’ll negotiate with providers on your behalf and help resolve billing disputes.

5. Educational resources

Take advantage of educational resources and guides available online to help you better understand medical billing terminology, insurance coverage, and healthcare costs. A helpful resource, “How to Read Your Medical Bill,” can be found here on the CMS.gov website. Empowering yourself with knowledge can help demystify the billing process and make it more manageable.

Using your tools and resources

While medical billing may seem complicated at times, it’s good to remember that there are resources to help you. By paying greater attention to your medical bills, including reviewing your EOB, asking questions, and leveraging patient portals and advocacy services, you can gain greater clarity and control over your healthcare finances.

As a MASA® member, you’re never alone in navigating this difficult terrain. We’ll take the complex process of managing medical transport billing off your hands, so you have complete peace of mind. We’ve designed our plans to provide comprehensive coverage and care when we know you need it most, so you can focus on your recovery and avoid navigating the medical billing maze.

¹ Cedar, “Annual Healthcare Financial Experience Study,” 2024