How to Correct Medical Billing Errors

medical billing errors

medical billing errors

Over ten million Americans with employer health coverage spend 10% or more of their overall income on out-of-pocket medical expenses—and that’s with insurance. With the high cost of healthcare, it is worth it to take a closer look at every medical bill before paying. If your medical bill says you owe a certain amount, don’t take that number at face value. Proving you don’t owe as much as the bill indicates can take some time and effort but it could be worth it in the end.

The best way to ensure you are not getting overbilled for medical care is to keep all of your medical and insurance paperwork organized. Keep all documents you receive concerning your medical care. You should receive an itemization of services to identify exactly what your provider is billing your insurance for. You will also receive an Explanation of Benefits (EOB) from your insurance company explaining why they can or cannot cover the services of your provider. You can compare these two documents to ensure your provider and your insurance company match in their estimation of your contribution.

If you are comparing your EOB with the itemized bill from your practitioner and something doesn’t seem right, there are four main ways you can investigate your charges:

1. Comprehensively Understand Your Benefits

Understanding what your insurance did or did not cover and why will help you evaluate if the bill is correct. Re-read your benefits plan, talk to your HR department for a refresher on your coverage, or call your insurance company to get help in understanding your bill. Know what your deductible is and what your insurance should be covering to make sure this is reflected in your EOB.

2. Know how to Spot Incorrect Coding

Every medical service has a corresponding code that tells your insurance company how you are being billed. If a medical code is just one number off, you could be billed for thousands of dollars more for a more complicated procedure than what you really received. Usually a quick Google search will help you identify what kind of service the code stands for. Healthcare Bluebook is also a great resource to identify codes and provide an estimated price for the service in your area.

3. Be on the Lookout for Upcoding

When a provider charges a patient for a higher level of service or equipment than was provided, it is called upcoding. While this can be the result of human error, it can also be a sign of medical billing fraud. When you are checking the codes on your itemized bill, pay attention to the level of care indicated. If you feel that the level of care indicated is not appropriate, you should question why your provider decided to bill you in this way.

4. Look for Unbundling of Charges

Bundling is when a group of services for a single procedure are entered under one code so that the patient pays the provider a single payment. Unbundling is when a provider charges the patient individually for different services or if the provider charges you for the individual services on top of the bundled code. Unbundling usually results in higher charges. For the average person, picking out unbundling practices on a bill can be hard. If anything seems unclear or too high to you, ask your provider to give you an itemized bill that provides clear explanations of the codes. You can also ask your insurance company to explain what services are included in a bundled service.

If anything seems off after looking over your bill and you think you are being overcharged, it is time to talk to your provider. Stay calm and professional when questioning the billing error. More often than not, a coding mistake is the result of simple human error. That being said, don’t be afraid to ask for action to be taken and any documents you will need to dispute your bill. Your medical records can help you compare what services your doctor says you received and what the bill says you received.

When a medical provider won’t budge on a bill that you feel is erroneous, you can contact your insurance company’s anti-fraud department to help you dispute the charges. If the process is becoming overwhelming and difficult to handle on your own, consider seeking outside assistance from an attorney. Medical billing errors can cost unsuspecting patients thousands of dollars. It is well worth the time and headache to ask the important questions to make sure you are being charged properly AND for the services you received.

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