Understanding your health insurance bill can help save money and catch errors. A recent NerdWallet analysis of 2013 hospital audits by Medicare found that an average 49% of bills contained errors, and that some medical centers messed up on more than 80% of claims to Medicare.
Every person who receives a medical bill should scrutinize it thoroughly.
Errors are not usually done intentionally, so realize that mistakes will happen. Even if 99% of medical bills are done correctly, there will still be errors. People still process these and to err is human.
The first step is knowing exactly what you’re being charged for. Can’t tell from the bill? Ask the provider for an itemized statement. Then compare the itemized statement to your Explanation of Benefits (EOB) you received from your insurance company.
Once you have your itemized list of charges, be on the lookout for the most frequent billing mistakes.
COMMON MEDICAL ERRORS
Duplicate charges. Make sure a service or procedure isn’t listed more times than it was performed. Duplicate charges are surprisingly common.
A treatment, medication or procedure you didn’t receive. If you were scheduled for a test or procedure but it was canceled, it could still end up on your bill because no one struck it from your chart.
Charges for basic supplies. Patients sometimes discover fees for gloves, gowns or other routine items listed separately on their bill.
Room fees. If the bill includes a hospital stay, check that you were charged for the right kind of room (shared or private) and the right number of days. If you were formally admitted after midnight, make sure your charges start on that day. Also, most insurance companies don’t allow hospitals to charge room fees for the day you’re discharged. So make sure the dates are correct and that you weren't up-coded for a room you didn't get.
You’ve found an error, now what?
When you spot an error, ask the billing department to start a formal dispute. Put your concerns in writing. Include any documentation you have and request that the provider support its claim as well. Also, you should notify your insurer of the error.
If your insurer should have covered the bill but didn’t, call them and find out why. It is possible that your physician did not provide the right documentation to get the procedure covered. You can submit an appeal with the insurance company and can ask the physician to provide more information.
Typically you don’t have to pay disputed charges until the investigation is complete, but you should pay the rest of the bill in order to avoid getting sent to collections. Also try to always respond promptly to billing communications. Responding to communications can prevent you from getting sent to collections which negatively impacts your credit score.
MediBookr Advocacy Team
Did you know that MediBookr’s advocacy services can help review your medical bills and dispute them for you? You don’t have to go through the hassle by yourself! We have a team of specialists who can review your bill for errors, dispute the charges, and even negotiate a different rate. Call us today at 1-800-822-8936 or email us at firstname.lastname@example.org.
-Dr. Ronnie Shalev is the Chief Medical Officer at Medibookr and is a board certified Emergency Medicine physician