Medical billing is wrought with errors and overcharges. Here’s how to avoid overpaying.
The next time you receive a medical bill, read it carefully. It’s not uncommon to be charged for services you didn’t receive.
Because they’re usually unexpected, medical bills can force otherwise financially savvy consumers into collections and cause long-term credit woes. In the worst-case scenario, medical debt can cause bankruptcy. In fact, medical debt is the leading cause of bankruptcy, and as such, can be a source of shame for those affected by events largely out of their control – until now. Here’s what to ask to help avoid the road to ruin, paved by medical bills.
1. Is this statement comprehensive?
Oftentimes a health care provider, a doctor or medical facility will send you a bill with one lump sum and few other details. This is akin to going to a grocery store with no price tags and being handed a short receipt with only the amount you paid to the store. How can you check to make sure nothing was charged by accident or snuck in under your nose?
You wouldn’t stand for that at the grocery store, and you shouldn’t stand for it with your health care. Paying any bill without an itemized listing of services is a big mistake because you simply don’t know what you’re paying for. You’re entitled to this itemized medical bill, so calling the billing department and requesting a full, detailed statement should work.
2. Are all identifiers correct?
The last thing you probably expect to cause a claim rejection by your insurance is something as simple as a misspelling, but this is a very common error. It’s also easy to forget to update your health insurance provider when you move; it’s equally easy to forget to update your doctor with new insurance.
“Everyone makes errors,” says Adria Goldman Gross, president of MedWise Insurance Advocacy, a group that helps consumers navigate medical bills and health insurance to help ensure fair rates. It’s not limited to your personal information, either. “Be sure the medical bill includes the correct medical insurer address, policy number and group number,” Gross adds. If any one of these identifiers is incorrect or incomplete, it could cause a complete claim rejection by your insurer.
3. Did I receive all of these services?
Whether by honest mistake or illegal billing practices, items can show up on your bill erroneously. Sometimes, a doctor orders a test and cancels it before it’s done. Other times, you may have a bad reaction to a medication and stopped taking it after one dose, but multiple doses end up on your bill. In both of these cases, you should be charged only for what you used. Keep an eye out for duplicates, too. Believe it or not, in some medical billing programs, duplicating a charge is as easy as accidentally hitting the return button an extra time.
Then again, sometimes a false item on your bill isn’t so innocent. “There have been fraudulent claims sent to health insurance carriers,” Gross says. But the health insurance claims processor doesn’t know what was actually performed during the visit, and your insurance may not cover what they are falsely billing you for. To guard against this practice in the future, Gross says, “it is best to keep track of the procedures that you experienced, and check the charges against your bills.”
4. What else looks fishy?
Incorrect identifiers and extra charges aren’t the only errors medical billing employees make. When the description of the billing item is vague, or you’re not sure from the description if the CPT code is correct, you can look up the code on the American Medical Association’s website. Other common errors include:
- Billing for a private room when you were in a shared room.
- Upcoding, or charging you for a higher level of service than you received, especially if emergency services were used.
- Operating room overcharges. Anesthesia records should have start and stop times, and operating rooms usually charge by the minute, so you can compare the times of each to ensure your OR fees aren’t too high.
- Unbundling errors occur when you are billed for a group of services under one code and again separately using a different code.
These errors aren’t the only things that can cause your bill to skyrocket. Many hospitals and medical centers routinely charge exorbitant fees for supplies such as gowns and gloves, or toiletries. A $1,000 toothbrush and $300 for hospital gowns and gloves are not unheard of. Just because a charge like that is on your bill doesn’t mean you have to pay the full cost. Medical bills are negotiable.
5. Where is my EOB?
Your explanation of benefits, or EOB, should be sent to you shortly after the medical claim is processed by your insurance provider. Health insurers send these by mail unless you are enrolled in a paperless service, in which case you should receive your EOB via email. Aside from checking for errors and addressing overcharges, ensuring your bill was covered appropriately is key to avoid overspending.
“The EOB indicates date of services, medical bill charges, what was covered, how much money the insurer considers to be reasonable and customary, the amount that went towards your deductible, copay and how much money you might be responsible for,” Gross explains.
You can check the EOB against the bill and your insurance policy at the same time to make sure everything was covered that should have been.
6. What needs to be adjusted?
Once you’ve gone through your itemized medical bill, checked it for errors and checked it against your insurance policy, you’re nearly done. If you can’t find anything wrong with your bill or anything suspicious about the charges, it’s time to go ahead and pay. If you can’t afford the balance, don’t fret just yet – you can still get help for that.
On the other hand, you may have a series of notes and concerns about the accuracy or fairness of the bill or insurance claim. If this is the case, you have a few more steps to take care of, but the upside to that is they will most likely save you money.
First, call the hospital’s billing department and relay your concerns. Your best bet is scheduling a face-to-face appointment with a billing representative.
If one of your concerns is an unreasonable fee for a particular service, prepare by using a price comparison tool online ahead of time so you can suggest a reasonable charge. During this appointment you can go over the errors you’ve found and discuss fair pricing. You can also explain what you can actually afford to pay in hopes that some charges will be reduced.
After this appointment, the claim should be resubmitted to your insurance company. If there are any services they didn’t cover and should have, you can contest their decision as outlined in your insurance policy – it’s required by law to be plain and clear. If all of this seems too much to handle, consider hiring a medical billing advocate to help you navigate the medical billing world.