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Common medical billing issues include denial of insurance benefits because the prescription or treatment is considered not medically necessary, claims partially paid that leave the consumer with an unexpected balance to pay, denials of assistance to those with substantial medical charges, incorrect medical bill collections and difficulty negotiating the internal or external appeals processes once a denial is issued.

To avoid these and other medical billing issues:

• Discuss your treatment plan with your doctor and hospital prior to receiving services to ensure there are no hidden charges.
• If you have insurance, make sure you know your policy’s guidelines for coverage before you receive treatment to avoid surprises.
• Be sure to keep the Explanations of Benefits (EOB) you receive from your insurer. If you believe a payment is incorrect or not sufficient, follow the appeal procedures available through your insurance plan.
• Contact your doctor or hospital’s finance manager to negotiate a reduction in anticipated or assessed medical charges. Often times, clinics, providers, and hospitals offer financial assistance services to qualified patients.
• If you have issues with the collection of a medical bill, see our information on debt collection practices.

Prescription Drugs

Prescription drug prices take a bite out of consumers’ wallets, but there are a number of things consumers can do that can help make their necessary medicines more affordable. First, ask your pharmacist:

• Is this prescription medication available in a generic form?
• Can I purchase more than a month’s supply of this prescription, and if so, will I save money by doing so?
• Are there any rebates available to me if I purchase this drug?
• Will your pharmacy match a lower price offered elsewhere?
• Does your pharmacy offer a discount to senior citizens?

Generic drugs

When shopping for prescription medication, always ask if a generic form of the medication is available. Generic medication is less expensive than its brand-name counterpart, particularly when there is more than one generic company manufacturing the drug.

Drug prices are not the same

The price of prescription medication can vary from pharmacy to pharmacy. In some instances, the price differences can be significant. Shop around to find the best prices for your medication. Be aware that prices change on a frequent basis. When contacting pharmacies for pricing information, document who you speak with and the price reported to you.

Licensed internet pharmacies

The State of Arkansas regulates the sale of pharmaceutical products in stores or pharmacies and over the Internet. These regulations help insure that Arkansans can purchase medications from reliable sources. Licensed Internet pharmacies are an alternative to standard retail pharmacies. Before you purchase medications from an online pharmacy, you should confirm that the pharmacy is licensed to do business in Arkansas. If you have a question about whether a pharmacy is licensed in Arkansas, contact the State Board of Pharmacy at (501) 682-0190.

Supplemental insurance

If Medicaid or your insurance does not cover all of your prescriptions, check to see if there is any form of supplemental insurance that will help you save money on your prescription medication. Before purchasing this kind of supplemental insurance, check to see if it will indeed save you money on your medications.

Prescription discount cards

Prescription discount cards offer savings on prescription medication. It is important for consumers to understand that prescription discount cards are not insurance. Legitimate cards are both sold and offered for free. Before purchasing a prescription-discount card, check to see if it will actually save you money. Some prescription-discount cards may not offer the cost savings you anticipate. If you decide to buy a discount card or join a discount program, remember that State law provides that you have 30 days to cancel your purchase if you are not satisfied with the card or program. If the card is offered for free, you should not be required to provide any personal identifying or financial information.

Prescription assistance programs

Many pharmaceutical companies voluntarily offer their medications at little or no cost to low-income individuals through prescription-assistance programs or PAPs. Unfortunately, many Arkansans are unaware that these PAPs may be available to address their prescription needs. To apply for prescription assistance through these programs, consumers must submit an application directly to the pharmaceutical manufacturer. The manufacturer then determines whether the consumer is eligible to participate in its program.

Nutraceuticals

Nutraceuticals are not medicine. Unlike pharmaceutical drugs that have been tested and are proven effective to treat a specific condition, nutraceuticals are food, beverage, vitamin, weight loss and other products that merely purport to provide health or medical benefits. Often these products are marketed through the use of testimonials from consumers or physicians. But, it is important to note that none of the claims made in these testimonials have been subject to qualified independent analysis by the Food and Drug Administration. For that reason you will often see a disclosure in the advertisement that the results reported in the testimonials are not typical.

Nutraceutical products are often marketed by offering “free trials.” Offers suggesting that you can try the product with no risk of incurring a charge should be approached with caution. Before you accept a free trial offer, read the fine print paying particular attention to the terms and conditions, privacy policy, and cancellation policy. Your free trial period may end before you have time to try the product or you may be enrolled in some other “membership” plans you did not intend to join. In addition, the vendor’s privacy policy may allow them to share your personal information including your credit card information with other entities. Finally, you should pay attention to any “checkboxes” on web pages to ensure your order is correct and you are not charged for items you do not want or need.

If you are billed for any product or service you did not order, consider filing a complaint with our office.