FAQ for Accepted Patients

What is an Itemized Bill?

 

The first bills you got from the hospital and doctors are usually the BILL SUMMARY, which gives a general summary of charges.  The following is an example of a summary bill from an ER visit.  In this case, the patient went to the ER, had some imaging done, got some laboratory tests, and took some medication. Note that while the bill broke down general categories of service, it did not show in detail what had been done.

We need the ITEMIZED BILL, which you can request by calling the healthcare provider.  The itemized bill contains details of what had been done.  This bill will have columns titled as Service Code, CPT Code, HCPCS Code, Revenue Code, and / or Diagnosis.  Not all columns will be present, but you need to look for bills with columns like these to send to us.  

 

In the example below, with the itemized bill, we now know that the imaging done was an MRI of the brain, the medication was Methylprednisolone which was an allergy medication, the medication was likely injected through infusion, and there were some miscellaneous laboratory services.  This patient probably visited the ER due to a severe allergic reaction.

What is Explanation of Benefits (EOB)?

The EOB is sent by your insurance company, so you will only have one if you are insured.  After your visit, the hospital and doctor(s) will send claim(s) to your insurance company to try to get paid.  The insurance company will evaluate the claim and determine what to pay for and how much. It will then send an explanation of benefits to you, and pay the claim to the hospital and doctors.  The EOB will usually state that "THIS IS NOT A BILL", because it is basically an explanation of their decision to pay or not pay for certain services.

Healthcare billing is very complicated.  If the health insurance company deny certain parts of the claim, the hospital and doctor may come after you for the difference.  This is why we need the EOB, so we can determine who is actually sending you the bills, and why.

How do we handle the security of your personal data?

We understand and respect the fact that you are sending deeply personal information to us, and we take data security very seriously.

  1. We don't take on every case.  If we don't think our strategy can help you, we will let you know, and won't even ask you for your personal data.

  2. When we accept your case and ask you for your personal information (like detailed medical bills, and sometimes pay stubs and tax returns if we pursue an income based hardship strategy), we will create a folder specifically for you on our secure server, and ask you to upload the information directly.  The server is hosted by Microsoft with Enterprise level security.  The folder will be tied to your email address, and can only be accessed after you have been validated by Microsoft.  See here for details.  

  3. Your case file and interactions with us are stored in salesforce.com cloud, which is arguably the world's best customer relationship management solution.  We chose to store data on the cloud instead of on-site due to a much higher level of data security. See here for details.  

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California Medical Billing Advocates

1390 Market Street STE 200

San Francisco, CA 94102

415-632-3316

info@calmba.org

©2019 by California Medical Billing Advocates, Inc.

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