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Medical Treatment: Records & Bills

The majority of your time and attention will be focused on your medical records.  It is the single most important piece of information the adjuster will use to adjust your claim.  You want to make sure you request and receive a complete copy of your medical records AND bills.  You will need to send each medical provider a letter requesting your chart and bill.  Use our Record Request Log, filling in the applicable information.

This is going to be the biggest “administrative” work you have to do with your claim.  But, it is absolutely key that you execute this task well.  You must be organized and stay on top of requesting and following up with numerous medical offices to get records.  You will face such things as:

  • Some asking you to sign a HIPAA (even though they are your own records);
  • Some asking for pre-payment to pull, copy, and send you your records;
  • Some only sending you your chart but not the bill;
  • Some only sending the bill but not the chart;
  • Some offices that maintain medical records in house but outsource billing, requiring you to make a separate request;
  • Receiving an incomplete set of records.

Getting Records

Getting your medical records and bills requires some phone calls and letter writing.  Here are the steps to get started:

  1. List all the people/facilities where you received medical treatment on the Records Request Log.
  2. Track down a phone number for each medical provider
  3. Call each and ask:
    • The address and department of where you should send your records request. Confirm that you can send your request for both records and bills to the same address.  Sometimes you need to send billing records requests to a different department or company.
    • If you need to mail or can you fax request (fax is faster).
    • If pre-payment is required.

Using The Records Request Log

The Records Request Log is the same worksheet used by ClaimClinic’s founder in his personal injury practice.  It is the key to staying not only organized but also to keeping your claim moving forward.

You should write down every medical provider that you have seen.  If you went to the ER, you should also leave place holders for the ER doctor and radiologist, who you won’t know the name of until you get your records.

When you send each request, write the date sent on your Record Request Log.

Each time you call to check on a request, make a note in the comments field for that provider.

Requesting Bills

It is not good enough to just use the bills you have received since your accident.  If you are in a HMO, you may not even see a bill, but still need them for your claim.  You must get “fresh” copies of all bills from the providers for several reasons.  First, the bill they send you will be complete.  Sometimes you will get bills in stages and you want to make sure you have the true TOTAL cost of your treatment.  Secondly, the bills you receive will show write-downs and reductions for health insurance, etc.  You are entitled to the full value of your hospital bills when you settle your claim, not just your out-of-pocket!  Many adjusters will try to give you just your out-of-pocket.  This is wrong.  Don’t let them short you on the full value of your claim. You get a copy of the bill directly from the provider because it will have an accounting of the full charges and will also be easier to redact the irrelevant write-downs.  Third, you get bills directly from the providers because they will contain information not contained in the bills you receive.  The provider’s bill will have ICD and CPT codes, which are extremely useful in documenting your claim.  Fourth, the bills provide an important double check to the bills you have received.  You can also double check your amounts by logging into your health insurer’s site and downloading your EOB (Explanation of Benefits).  This will have a chronological list of all the bills they have received and processed on your behalf.

You need to make sure (i.e. that you request and receive) documents from your medical providers list the ICD and/or CPT codes they used to bill your treatment.  ICD stands for “International Statistical Classification of Diseases and Related Health Problems.”  They are designations given to every diagnosis, description of symptoms and cause of death attributed to human beings.  CPT codes on the other hand, refer to all the treatment performed.  CPT means “Current Procedural Terminology.”  CPT codes are used purely for billing purposes.  Health insurance companies use the codes to determine reimbursement amounts.  ICD and CPT codes are heavily used by insurance companies for inputting data into their claims evaluation software.

Looking For Independent Contractors

Finding and obtaining hospital bills, whether for emergency room treatment or surgeries, deserve special attention.  When you request the hospital’s bill, you are only getting the bill from the hospital for it being the facility where your treatment occurred and the supplies/equipment it provided to you.  The doctors are usually independent contractors.  So, you will need to identify who your ER physician was, your radiologist, your anesthesiologist, your surgeon, etc and get their bill separately.

There are a couple of ways to identify the various independent doctors who helped with your treatment.  Your medical records will list the doctors, which you can then Google to find their office contact information.  If you have been saving all your bills and EOB’s you have received, chances are you have received something from each person stating their charge.

Receiving Records

Go through the following checklist each time you receive in a set of records or bills in your claim.  The Medical Records Dissection Worksheet has this checklist on the front page so that you can mark it up as you work through dissecting your records.

  1. Confirm you received all records and that some DOS (dates of service) were not skipped
  2. Bills received too?  If not, follow up with the provider to get the bills.
  3. Is this a Hospital Chart?  If so, identify and request ER Doctor and Radiologist bills if you have not already done so and add ER Doctor and Radiologist to RR Log (Records Request Log) if necessary
  4. Update RRL with the date of receipt for the records and/or bills.  You update the RRL by changing the row’s font to strike through. That way you know it is done but can still see it listed as one of your medical providers.
  5. Separate Bills from the Chart – i.e. create 2 separate documents
  6. Re-Order Medical Chart from earliest appointment to last appointment. You should be able to read through the records from front to back in chronological order.
  7. Confirm no missing pages as you re-organize the chart.
  8. Copy Records so you have a clean copy to give to the adjuster later.
  9. Update Medical Records Index sheet by adding new box on right-hand side column.  Put Provider’s name and dates of service in the new index box.
  10. Print Updated Medical Records Index sheet x2 – once for your working records and once for the adjuster’s set.
  11. Insert Next # Tab x2 behind the last page of the medical records – should be same as number on the Medical Records Index Sheet.
  12. Insert this Dissection Worksheet directly behind the # tab.  Do this for both your set and the adjuster’s set.
  13. Place Received Records Behind # Tab x2 – now we have a working copy of the records with this worksheet on top and a clean copy for the adjuster.

Before making your copy, take the medical records and sort them into chronological order with the very first office appointment on top and the most recent (or last) appointment at the very back.  This will be critical when you go to dissect your records for their data. You want to be able to read the records front to back in chronological order.  It is imperative you sort them prior to copying so that your Clean Copy will also be in the same chronological order.  This way, the adjuster will have the records in order when they go to review them.

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