A Family Caregiver’s Guide to Doctors, Prescriptions and Hospital Bills

When your loved one is hospitalized, even for a routine procedure, have a written game plan to help ensure that nothing is overlooked. Here’s what you need to know. 

Step 1. Make sure the procedure is covered.

• Find out what Medicare covers. Enter the procedure, surgery or treatment to find out.
• If the patient is a Medicaid recipient, see what Medicaid covers. 
• If covered by private insurance, call customer service to confirm the hospital accepts your loved one’s insurance and the doctor performing the procedure is in network . If the hospital is in network and the doctor is not, ask if the company will cover the doctor’s fees.

Step 2. Find the right doctor and hospital, then:

• Contact your loved one’s insurer for preapproval.
• Ask for a confirmation number.

Step 3. Contact the doctor’s office a week before the scheduled admission.

• Go over instructions. These may include fasting requirements; temporarily discontinuing aspirin, blood thinners or other medications; and what to bring to admissions.
• Confirm length of expected hospital stay.

Step 4. Check in . Bring a to-go bag, containing your loved one’s :

• Legal, current photo ID
• Insurance, Medicare, Medicaid cards
• List of all medicines currently being taken, including vitamins and over-the-counter drugs, with doses noted
• List of questions and observational notes
• Names and contact information of doctors
• A short health history
• HIPAA agreement (This form allows hospital staff to share the patient’s medical status with you or another trusted person.)

Step 5. During hospitalization:

• Keep a journal to record your loved one’s condition, changes, appetite and mood. Note dates and times.
• Remember that every patient has a right to review his medical records and have terms explained clearly.
• If concerns go unanswered, contact the hospital’s patient representative.

Step 6. Check out. Before leaving, ask:

• What is the expected recovery time?
• What are the possible side effects?
• Are you prescribing new medications?
• Should the patient continue taking medication prescribed before hospitalization? Prescriptions? Vitamins?
• Will this be followed by patient rehab, physical or other therapy?
• When is the next office appointment?

Track and Pay the Medical Bills

Keeping tabs on the hospital tab is essential. Mistakes happen, and when they do, the claim will likely be rejected. These tips will help you track down and correct the error.

• Keep all medical receipts.
• If insurance, Medicare or Medicaid rejects a claim, call the business office for the provider, service, clinic or hospital. Ask for copies of medical records.
• Compare records with bills. Make sure your name, insurance number and the services provided are correct.
• Report unexplained or mistaken charges to the business office and ask for an explanation. Take notes. Include the date, time and name of the person with whom you spoke.
• If the issue is resolved, ask for a new statement.
• If the provider checks the medical coding, dates and services rendered but is unable to resolve the issue, contact the office that rejected the claim.
• If there is a discrepancy between the provider and the insurer, request that customer service set up a three-way phone call that includes you and the provider.
• If the issue remains unresolved and they believe their decision was correct, file an appeal.
• If paying the bill will create a hardship, ask if it can be adjusted and request a payment plan.