In America, it’s not uncommon to find yourself with a huge medical bill in your hands. Worse, the most expensive of them tend to come after a serious illness or injury, when you’re in no condition to worry about money.
Depending on the services you needed and the place you got them, your bill might look like a laundry list of charges with pages of minute details. Or it might look like one huge number with no context or explanation whatsoever. There’s no standard for consistency when it comes to health care billing, so it’s anyone’s guess what your bill will look like.
But there’s a good chance it will confuse you: 63 percent of Americans say they’ve gotten a medical bill that cost more than they expected, according to NerdWallet Health. You can search online for some terms and tips, but what if your bill is so confusing you need a real live human being to break it down for you?
Many people in this situation go first to the administer of their health insurance, the human resources personnel at their job. Whether that’s the best idea is hard to say.
The Human Resources Job Description
Medical bill deciphering and waging insurance disputes are low on the list of HR functions in typical American companies. Although human resources managers are likely to oversee administrative details like benefits plans, they also oversee hiring and recruitment, mediate office disputes and serve as a link between employees and management. Of course, HR managers exist in almost every industry, so job descriptions vary.
Since all of that is often a job description on its own, HR personnel may not know a lot about medical bills or health insurance terms. “That’s not what their training is in – your medical bills can be just as confusing for your HR department,” says Adria Goldman Gross, founder of MedWise Insurance Advocacy, a firm that consults with individuals and businesses on medical bills and insurance disputes.
Although HR teams are often able to offer information about your health insurance and provide the broker’s information, most HR pros are not medical billing or insurance experts. “They probably can’t look at the hospital codes and know off the bat if they’re right,” says Martine Brousse, founder of AdviMed, a medical billing advocacy firm.
Like Gross, Brousse also works with companies and independent patients who come to her with confusing or high medical bills. It’s always OK to ask your human resources team members for information; they just may not be the exact resource you need. More companies, however, are hiring these professional consultants as an added benefit for their employees.
Gauge by Size
Some larger companies may offer exactly what you need, however. “In my experience it depends on the size of the company and the size of their HR department,” says Joe Campagna, who owns HR consulting firm My Virtual HR Director. “If your company is large and your HR department has a dedicated benefit manager, then you are fairly safe to hand over the issue to that person.”
According to the Bureau of Labor Statistics, about 52 percent of workers are employed at large companies, or those with 500 or more employees. That number is from 2012, the last year for which data is available.
Smaller companies, on the other hand, probably don’t have the bandwidth to deal with those kinds of things. Smaller businesses often have a single HR manager on staff, or else HR duties fall to an office manager who’s juggling multiple responsibilities. “Then it becomes a little more dicey,” Campagna says. Managers “probably won’t know what to do with a medical bill when they get it,” and won’t have time to deal with it.
But that’s not the only problem. In smaller companies, where a manager may be performing HR functions, it’s less likely the manager has had any formal human resources training on matters such as confidentiality, discrimination and disability protections under the law. As a result, your information could be poorly protected, or you could become the subject of office gossip or discrimination.
“Such discrimination is mitigated by professional HR staff through well-defined controls and confidentiality,” Campagna says. “Managers should never know about your or your family’s personal health information unless there is a bona fide need to know.” In short, know the scope of your company’s HR department before you hand over your personal information to it.
A Newer Alternative
It wasn’t long ago that the HR team was your best bet for help with confusing medical bills, but the problem of health care billing has birthed a new kind of help. People such as Brousse and Gross are becoming more and more common, helping patients with billing and insurance disputes when others can’t.
Most of them come with decades of experience somewhere on the other side of health care billing. “I wanted to be a part of the solution, and not the problem,” says Brousse, who formerly worked as a medical billing manager. She learned a lot in that position, including creative ways to get bills paid and how to negotiate with insurance companies. “I can look at some hospital codes and see instantly where a patient has been overcharged,” Brousse says.
The primary job of medical billing advocates is negotiating – with hospitals to lower charges, with insurers to cover larger portions and with charities that help low-income families. “Everything is negotiable,” says Gross, who recently got a provider to drop a $32,000 surgery charge insurance wasn’t covering and the patient couldn’t pay.
A Word to the Wise
The major advantage your company’s HR department has over billing advocates is that its services are free. Billing advocates typically charge by the hour or as a percentage of savings, but since they’re in the business of saving money they’re often flexible on payment plans. They also often save clients more than they charge.
If you decide to hire a billing advocate, look for experience and not certifications, Brousse says. “This is such a new profession there are no boards who certify billing advocates,” she explains. “Look instead for someone who has years and years of experience.” That’s the best indicator that advocates know their stuff, she says.