Having to talk to your doctor about your HealthShare can be tricky. Providers and their employees are generally trained to deal with health insurance, not HealthShares. As HealthShares become more popular, they may know what HealthShares are. A few might even know how to work with one, but most will not. You need to be informed so you can help your provider and yourself.
You may need to explain what a HealthShare is, and you will definitely need to explain how yours would like bills handled. If your provider is unfamiliar with HealthShares, you can say something like this: “It’s an alternative to health insurance. A group of like-minded people joined this organization and we all pay monthly dues. We help each other pay medical bills.” You should make sure your doctor understands that a HealthShare is not insurance, and you want any self-pay discounts they offer.
For today’s blog, we will focus more on billing and how you should talk to your doctor to help them understand how to bill your HealthShare and make it easier to process your medical expenses.
What to know about billing
Read your HealthShare’s terms carefully. It would take too long to review every HealthShare’s instructions and list them here. The information would quickly become outdated, so this is up to you. If the instructions confuse you, call or email your HealthShare until you understand them. Take notes and have them ready to share with your provider during your visit.
All reviewed HealthShares on this site ask for itemized bills. An itemized bill is a document listing the actual cost of every service given, not just the total cost of the visit. Think of it like a grocery store receipt. If you go to Walmart and buy eggs, milk, a T-shirt, and some potato chips, your receipt will show eggs, milk, a T-shirt, and potato chips. Additionally, the receipt will show the cost of each item as well as the total—it’s an itemized receipt. Most healthcare bills are not itemized and only show the date, location, provider name, and total cost. If patients want an itemized bill, they usually need to ask for it.
CPT — Current Procedural Terminology
CPT codes are basically shortcut numbers describing services that are categorized into different groups (e.g. Anesthesia, Respiratory, Musculoskeletal). These codes are published by the American Medical Association and were most recently updated in September 2020. The current version of the code is CPT-10, so double-check whether your HealthShare is asking for any other version. Your provider’s office will be familiar with CPT-10. If for some reason your HealthShare requests CPT-8 or CPT-9, you need to ask the office staff if they can convert codes.
HCPCS — Healthcare Common Procedure Coding System
The HCPCS system includes the CPT codes. In fact, CPT-10 and HCPCS Level I are the same thing. However, HCPCS also has Level II codes (e.g. transportation, medical supplies, medications) and Level III codes (for localized programs). Level III codes are not nationally recognized and are not often used, so don’t stress. If your HealthShare requests HCPCS codes, assume that they want CPT codes or HCPCS Level II codes. Your doctors should know what these codes are and be able to produce codes for any procedures or services they give.
How to talk to your doctor
You’ve done your homework. Maybe you don’t fully understand all these codes, but that’s okay. The first part of your job as your own advocate was just to prepare, do your research, and be able to talk to your doctor about what your HealthShare needs them to do. The second part of your job is to tell your doctor the right way. Be proactive about getting bills and receipts from your doctor and submitting them to your HealthShare.
Most providers are already overworked. HealthShares are still new, and some have already developed a bad reputation for not paying bills. Your HealthShare may confuse your provider. Or, your provider may worry that it will be hard for them to receive payment for their work. Show them that you want to be a good patient. You can do this by giving them a good attitude, good information, and a good effort. Have your paperwork on hand along with contact information for your HealthShare. If something confuses your provider, offer to call your HealthShare and ask for that information (and then follow through).
It is very important to be patient and cooperative with your provider. When you talk with your doctor there should be no shouting, no passive-aggressive rhetorical questions (“why can’t you just do your job?!”), and no rudeness toward the staff. Even if the conversation becomes frustrating, you need to stay calm and prove that you want to help your doctor help you.
If it seems that your provider has a negative opinion of HealthShares the first time you bring yours up, take your time. Show them that you are a trustworthy patient. Relationships between provider and patient need to be based on trust. A doctor who is rude, evasive, or dismissive even after you’ve done your best for them may be a doctor that you need to fire.
It’s important to understand, though, that most doctors care about their patients and want to help them use the payment options that work best. So, rather than assuming the worst, remember that your provider is a human being who may simply be concerned or confused. Showing that you care about your health and their success should create a warmer relationship between you and your provider— all while soothing their concerns about your HealthShare.
The effort you put into talking to your doctor about your HealthShare will make it much easier for bills to be processed correctly, and that will make everybody happy. It’s worth the effort.