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.

Dealing with Medical Debt in New Jersey

medical debt in New Jersey

Medical debt can make you feel like you’re standing in a caving, intimidating hole with no way out. In what seems like seconds, medical bills accumulate until you’ve found yourself in a virtual gaping void of debt. In 2007, medical bills were the cause of over half of the filed bankruptcies in the United States, according to the American Journal of Medicine. Believe it or not, 80% of those who filed actually had health insurance as well as minimal debt when compared with those who filed without having health insurance. Unfortunately, we aren’t invincible, and expenses, especially medical bills, can cripple us. On the bright side, we have some tips that may just be the light and end of the tunnel.

1.      Face the Facts

The first and most effortless change that you should make immediately is to simply get out of denial. With every medical bill that is ignored, you’re digging yourself deeper into trouble, therefore ignorance is not the key. Because medical providers will only allow bills to pile up for a short amount of time, it won’t be long until your debt is forwarded to a collection agency. Once a collection agency receives your overdue debt information, it gets posted on your credit report, which ultimately hurts your credit score and future financial endeavors.

As you are looking over your medical bill(s), beware of any incorrect charges. Innumerable bills get sent out by medical providers each day, making mistakes inevitable. It’s possible that you were charged for a five-day stay in the hospital, when you really only stayed for three. If you spot an inappropriate charge, make haste and contact your medical provider’s billing department.

2.      Handling Health Insurance

Your health insurance company is responsible for taking care of certain charges. Make sure you check that your insurance company took care of the necessary charges. If a specific treatment is covered under your plan, the insurance company may still deny the claim which means the medical provider will end up adding that to your bill. If it’s a simple error, it shouldn’t be hard to fix. If your insurance company is trying to get out of paying for something, the task ahead may be more difficult. In most cases, you can appeal a claim, which requires you to submit evidence as to why your insurance company should pay for the treatment or service. If the evidence is valid, or you obtain a letter from your doctor regarding the necessary treatment, there is a possibility the denial could be overturned. Taking a proactive approach could save you a ton of money and damage to your credit score.

3.      Negate the Negative Assumption

Unfortunately, insurance companies think most of their clients are uneducated. In some cases, this is may be true. Medical service providers have pricing structures that waver quite a bit. If a hospital attempts to charge $1,000 for one prescription, you have permission to negotiate it. Since they assume that you have no idea about what you’re being billed for, medical providers will take advantage. If you work with them and let them know that you are unable to pay for the entire charge, but can cover some of it, they will be more cooperative than if you flat out refuse to pay. It’s possible that you may not feel comfortable negotiating, in which case, professional debt relief assistance is available in New Jersey.

4.      Communication is Key

If you are unable to pay off your bill in one lump sum, contact your doctor’s office to let them know that you are working with your insurance company to get the bill paid off. The billing department will be thankful and cooperative if you maintain an open line of communication. In a situation where you’re responsible for the entire bill, request a payment plan from your doctor’s office and be sure to review the budget. Don’t commit to a plan that you can’t afford.

5.      Pay It Off

Our final tip for you is simple: pay off the bills. We understand that this task is easier said than done. Take care of the small medical bills and work your way through the larger ones. Medical providers will appreciate your efforts much more than full ignorance. Once you have a plan and begin paying the bills, pay them on time every month.

Quick to build up but slow to get rid of describes not just medical debt, but many facets of life. Fortunately, it’s not impossible to deal with medical debt, but like many things, you have to take the first daunting step. We are here to help guide you through the process should you need our advice and/or assistance. If, even after taking the above steps, it seems unlikely that you will be able to pay off your medical debt, talk to Veitengruber Law about medical debt relief through chapter 7 bankruptcy.