Medical bills have the unsettling power to derail our lives. You probably know the feeling: as soon as you pull the envelope from the mailbox and spot the provider’s name, your stomach drops. Healthcare is hardly transparent, so even if you know a bill is coming, you never quite know what you’ll get.
HealthJoy’s Bill Review team works hard to help our members navigate this troubled process. They spend hours on each member’s request, coordinating between many different parties and steadily following up on tiny errors. But the results are worth it. We’re able to save members from paying bills out of frustration, losing refunds they deserve, and overpaying for services they didn’t receive, often to the tune of several thousand dollars.
“That’s what makes our job worthwhile,” Bill Review Team Lead Angelique Williams said. “When we locate errors, and we’re able to make a tremendous difference in the stress our members are feeling.”
Here’s a look at how HealthJoy’s team performs a Bill Review.
The initial request
A HealthJoy Bill Review begins when our members request it through our app and take a picture of their bill. Their reasons for submission can be uncounted: sometimes, members spot a charge they know is wrong or they receive a duplicate bill. A provider may charge members upfront for a service they believe should be covered by their insurance carrier.
Some of the most common Bill Review requests come from a misunderstanding of benefits. For instance, merely mentioning symptoms can prompt a change in billing codes that makes the difference between a test that’s covered as preventive and one that requires the member to pay. Working with a Bill Review Specialist can take the mystery out of this process and helps members understand how to seek care in the future.
“We try to provide our members with education and knowledge about how their benefits work, so they’re not surprised at the end of the day,” Angelique said.
Whatever the case’s details, our team only needs a photo of the bill or an Explanation of Benefits (EOB) to begin. The member taps “Medical Bill Review” from the app’s home screen, and our AI assistant, JOY, guides them through an intake process that includes uploading their photos.
From there, they simply sit back and let our US-based team get to work.
Coordinating with Providers and InsuranceTo get to the bottom of a Bill Review request, HealthJoy’s team relies on an in-depth knowledge of medical billing and coding intricacies. They also use persistence—the team could encounter a less-complicated bill that requires an hour or two or one that takes days of coordination that require lots of phone calls. “It depends on the situation,” Angelique said. “We don’t know what we’re going to encounter until we open the ticket and view the bills themselves. It’s like that Forest Gump quote – you never know what you’re going to get.” The average bill review ticket takes about two hours. For exampmle, let’s say a member is surprised by a bill and submits it to our team for review.
- First, the Bill Review Specialist will reach out to the insurance provider. They learn that the insurance provider doesn’t have a claim on file for the member—in other words, the insurance company is out of the loop.
- The Bill Review Specialist will call the provider who billed the member. They’ll give them the address they found during their conversation with the insurance company, asking the provider’s office to send the claim to the insurance company.
- Finally, they’ll ask the provider to put the account on hold. That last step means the member won’t be sent to collections while waiting for the provider to coordinate with their insurance.
More detailed claims or those with multiple bills require a more complicated process, often taking hours or even days. A few additional steps they might find in a more complicated process:
- The Bill Review Specialist reviews each bill for claims status.
- They contact the provider and insurance carrier about every bill.
- The Bill Review Specialist will review billing codes, diagnosis codes, service location, and more to look for errors and ensure the coding matches the service the member received.
- They’ll also check the member’s policy and ensure the insurance processed them correctly. If not, they’d request the claims be re-processed, regularly checking with all parties to track progress.
Getting it right often means setting reminders and circling back with all the involved parties. Ultimately, that persistence represents time our members don’t have to spend tracking down a confusing bill.
“We don’t leave loose ends,” Angelique said.
Communicating with the member
Once our specialists have gathered all the details they need to resolve the billing issue, they’ll send a detailed written response to the member through the HealthJoy app. The member can also choose to talk one-on-one with their Bill Review Specialist.
This process sometimes uncovers additional issues; perhaps a refund check never arrived, or the member received another bill just before the call. However, Angelique said her team’s goal is to close a case so thoroughly that the member never needs to pick up the phone.
“We know medical bills are confusing, so we always think ahead about the questions a member may have as they’re reading and try to address them in our response,” Angelique said.
HealthJoy Bill Review is free to all members, meaning they can always submit requests to our team, just in case.
“Every member who gets a bill should just send it to us,” Angelique said. “It doesn’t hurt to snap a picture and send it through, just to make sure that it’s right.”
“Billing mistakes happen,” she added. “We’re all human.”