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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Can a NJ Bankruptcy Forgive Gender Reassignment Surgery Debts?

NJ Bankruptcy

Bankruptcy is one of the more maligned aspects of the law. Unfortunately, some people feel like bankruptcy means they are a financial failure. But the truth is that bankruptcy can be a true lifeline when all other options have been exhausted. People on the brink or already in financial ruin can be given a clean slate and a chance to start over.

One specific group of the population for whom mounting debt is a real problem are those undergoing gender reassignment surgery. In some cases in NJ, gender reassignment surgery can be covered by health insurance when deemed medically necessary. However, even if a patient’s plan does cover the surgery, the costs can still be overwhelming. The process can span over a few years, and includes ongoing treatment including hormone therapy. Many gender reassignments require multiple procedures and/or surgeries as well.

Many aspects of a person’s transformation are considered “cosmetic” by health insurance companies and are therefore not covered. Some of these include voice alteration, jaw reduction, chin implants, hair removal, lip reduction, pectoral implants, and more. The costs can quickly spiral out of control. Medical bills can easily cripple your finances and declaring bankruptcy may be the only viable solution.

 

What Chapter Is Right for You?

It’s important to have a lawyer on your side who can help you navigate the confusing differences in the various bankruptcy filings. Veitengruber Law can guide you through the process of determining which chapter will be right for you and your future financial health.

Individuals can file for New Jersey bankruptcy in one of two ways: Chapter 7 or Chapter 13. There are important differentiations between these two types of bankruptcy and it’s important to choose the right one for your unique situation. If the medical bills from gender reassignment surgery are your chief debt, you can find relief through debt discharge in both of these filings.

 

The First Step

Before any individual may file for either Chapter 7 or Chapter 13 bankruptcy, they must receive credit counseling from an approved non-profit counseling agency within 180 days.  Veitengruber Law can assist you in this process. We can help you choose an agency that qualifies, that will work with you on the fees if necessary, and that will be the most beneficial for your financial education. The main objectives to the credit counseling are to instruct you on how to remedy your current poor finances and how to achieve and maintain financial health.

It is entirely possible after credit counseling to discover that filing for bankruptcy isn’t actually necessary for your situation. You may be able to work out payment plan(s) or pay negotiated sums to pay off your medical debts. In addition to your medical debts, you can naturally include other non-medical debts within the same bankruptcy. Some creditors will be more willing to accept reduced balances if they are aware that you are beginning bankruptcy procedures. To them, a portion of repayment is better than discharged debt, which will mean they end up with no payment at all. If, however, you are unable to come to a solution after attempted negotiations, bankruptcy may in fact be the best course of action.

 

Chapter 7

If you don’t own property or many assets, this may be the course for you. In Chapter 7 cases, the debtor’s assets are given to a trustee who sells them off to pay your creditors. Certain personal property is considered exempt, however it is important to know the rules specific to your state. There is a list of federal property exemptions and NJ state exemptions. You can choose which list you are going to use, but you cannot use both. That is why consulting with a local bankruptcy attorney can be the difference in saving thousands of dollars of lost property. If you have no personal property to liquidate, it can still be possible for you to file for Chapter 7 with the help of an experience New Jersey bankruptcy attorney.

After your assets are liquidated and creditors paid based on priority, the remainder of your debts will be discharged – with certain exceptions – like student loan debt.

 

Chapter 13

Chapter 13 bankruptcy is that it gives the debtor a chance to reorganize. The petitioner must file a plan of repayment to creditors that will usually take place over a period of three to five years. After the repayment period ends, the debtor will receive a discharge of the remaining debts. The key difference between Chapter 7 and Chapter 13 bankruptcy is that in Chapter 13, the debtor remains in possession of their assets. If you own a home or other property, you will want to consider Chapter 13. This is another situation in which a knowledgeable bankruptcy attorney like George Veitengruber is invaluable, because he can guide you to the type of bankruptcy that will be most beneficial for your situation.

 

Post-petition Debts

From the date that you file your claim, any additional debts you incur will not be included in your bankruptcy case. This can be a major consideration in your decision to file if you are trying to clear debts from gender reassignment surgery. Medical bills can be extremely slow to process. Each doctor’s office must bill medical insurance, wait for the claim to process, receive the claim, and then bill the patient. It can be weeks or months from the date of a procedure to when you receive the bill. If you are accumulating debt from multiple procedures, you may want to wait until after you have been billed for all of your procedures and appointments before filing. When you file your bankruptcy claim you will be required to provide a detailed list of all the creditors and amounts due. Any debts that are incurred after the date your petition is filed, will not be discharged and you will be responsible for paying them back.

Undergoing a major transformation like gender reassignment is a life-changing experience. If you need to go through bankruptcy proceedings, don’t be intimidated.  George Veitengruber is an experienced attorney who can guide you through the process every step of the way: seeking credit counseling, negotiating credit balances, choosing the right chapter, maximizing your property exemptions, minimizing your post-petition debts, and making sure much of your debts are discharged, including medical debt from gender reassignment surgery.

Late Payments: Will They Affect my Credit Score?

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By now, you probably understand that failure to make good on your debts will definitely be reflected in your credit report and score. Regardless of your reason, leaving debts unpaid opens you up to numerous marks on your credit report, which will in turn drag your score down, down, down – until the debts are paid.

So, not paying your debts equals a low credit score, but what happens when you do pay, but you pay late?

Will late payments be reflected on my credit report?

The best answer here is “it depends.” If you make one or two utility payments that are only late by a few days, they probably won’t show up on your credit report. (But they might! Much depends on the company’s policies and the individual in charge of receiving payments for that company.)

Many times, medical debt causes significant headaches for consumers. Usually the headaches are caused by dealing with insurance companies. Insurance companies are notoriously bad at responding to claims in a reasonable time frame, which leads to red marks on your credit report. Often, codes are submitted incorrectly or multiple insurance policies are not properly coordinated. Further, some claims are initially denied but may be approved if resubmitted through the proper channels.

The bottom line regarding medical debt is that human error combined with strict and sometimes questionable policy rules lead to long wait times for some claims to be paid by insurance companies.

Why is my medical debt marked “Late” on my credit report if it is the insurance company’s fault?

This question comes up often, and the unfortunate reality is that creditors, even hospitals, doctors’ offices and other medical providers, do not care who pays their bill as long as it gets paid. Most providers do realize that there may be a slight delay for payment due to the intricacies of the insurance industry, however, they are not willing to wait for an extended period of time.

Patients who are waiting for their insurance company to pay their medical bill(s) are often surprised to find negative marks on their credit report because they don’t understand that if there is a delay on the insurance company’s side, medical providers expect the patient to pay the bill and then be reimbursed by the insurance company.

If you’ve recently discovered that some of your paid medical debt has been marked as “Late” on your credit report, you may wonder if you can get your provider to remove the “Late” status now that they’ve received payment. Unfortunately they don’t have to and typically won’t remove the “Late” mark from your report because doing so takes up more of their valuable time.

Additionally, if your medical debt was in fact paid late then it is accurately denoted on your credit report. The fact that it is marked as “Paid” is important (even if marked “Paid Late”), and you can add a note to the entry so that future creditors know precisely why it was paid late. If, however, your medical debt was paid and your credit report does not reflect payment at all, then you have a right to have the information changed.

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Negotiate Your Way Out of Medical Debt!

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Undoubtedly, one of the most stressful types of debt to deal with is that which you have incurred because of your health. Medical debt can be so frustrating because of the high dollar amount that doctors, hospitals and other medical providers charge for their services. And, although medical debt is typically experienced by those without health insurance, even insured individuals can find themselves in debt if they require a procedure that insurance won’t pay for.

In fact, medical debt aside, you may very well have a really great credit score. If you have large medical debt(s) that you can’t even afford to make a dent in, they’ll end up multiplying astronomically due to late charges, leaving you with an even bigger problem in time, and a very low credit score.

The most important thing you can do when attempting to rid yourself of medical bills is to become as familiar as possible with what the actual costs are of any procedures you had or will have in the near future. You’ll want to determine an average of what the hospitals and physicians nearby would charge for the same procedure.

Armed with the actual costs of the procedures in question, you will then be much better equipped to negotiate with your physician’s billing department. However, it is also essential that you use a confident yet kind approach. Explain your situation and don’t be afraid to make it personal so they understand your struggle. Ask if you can pay the same amount that an insurance company would pay for the same procedure.

If you are able – offer to pay the discounted amount in full. You can offer this before you’ve even had the procedure to avoid medical bills from piling up in the first place, or you can offer to pay in full (at a negotiated discount) if you owe money on a past procedure.

In case you meet with resistance regarding your request to pay less, press onward and upward. By that, we mean find out who the billing manager’s boss is, and call them next. If you still meet resistance, go even further up – even as far as the hospital’s financial CEO or the equivalent.

When you do arrive at a discounted rate that appears to be the best deal possible, set up a payment plan and get the details of the plan in writing. Be sure to stay on top of making your agreed-upon payments on time. This will make it more likely that the provider will forgive the remainder of (or at least a portion of) your bill later on down the road, when you should revisit the situation and attempt once again to ask for debt forgiveness.

Should you be unable to come to a discount agreement with your physician, hospital or other provider, it’s time to reach out for help. Veitengruber Law specializes in helping our clients find debt relief solutions of all kinds, including medical debt. While it may initially seem scary to owe someone else money while attempting to reduce your debts, your return on investment in our team is well worth it. The money we’ll be able to knock off your medical bills will make our fees look like chump change. Bonus: We’ll consult with you FREE of charge!

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Don’t Let Medical Debt Push You into Bankruptcy: Know Your Rights

medical records

The level of medical debt in America has reached crisis levels, and is in fact the top reason that people in American file for bankruptcy. One of the reasons for such extreme amounts of medical debt is that medical bills in the U.S. are often fraught with mistakes. Unfortunately, many times these ‘mistakes’ made by doctors’ billing centers, are in favor of the doctors rather than the patients.

Although there have been some recent changes to the health insurance system in America, there is still a gigantic lack of transparency when it comes to how much you will ultimately be expected to pay out of pocket. This leads to patient confusion. Many times, you may be under the impression that your insurer will pay 100% of the costs related to a medical service, only to later discover that your insurer pays your physician a lower rate than s/he would like to be paid. Often, doctors will attempt to get you to pay the amount (or in some seedy cases, more than the amount) that your insurer did not pay.

This is called balance billing, and is not only frowned upon in New Jersey – it’s illegal. If your medical debt includes any balance bills from doctors, it’s important to know that you are NOT required to pay the balance between what your insurance provider pays and what your physician wishes they would pay. Bring the bill’s attention to your insurance provider – they need to be made aware of any potential insurance fraud practices that may be occurring within your medical network, and they are the best enforcers of the anti-balance billing law.

On the other hand, if you have mountains of medical debt because you’re uninsured, or were uninsured in the past, it’s still quite possible that many of your medical bills contain errors or overcharges. Because there aren’t currently any medical pricing standards in the U.S., it is possible to negotiate your medical bills, both before and after you’ve received treatment.

Almost every medical billing office will work with you to find a payment schedule that works. They essentially want any amount they can get (the more the better, of course), and some is always better than none. If your medical debt is beyond what you can sift through and negotiate on your own, hire someone to do the negotiating for you. Although it may seem counter-intuitive to pay someone when you’re already in debt, your return on investment will be MORE THAN worth it.

A debt negotiator, usually an attorney with a lot of experience negotiating with debt collectors, will be able to so significantly reduce the amount of money you owe, that his/her fee will seem paltry in comparison.

Once your past medical debt is settled, plan for the future. Always ask your medical providers about their fees before you receive services. You can negotiate discounts for yourself, but you have to advocate and speak up! Don’t let overpriced medical bills pile up ever again. Keep yourself out of bankruptcy by knowing all of your options and getting all of your negotiated medical rates in writing.

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Can I Include My Spouse’s Medical Debt in Chapter 7 Bankruptcy?

medical bills

Due to billing errors and providers with questionable pricing regulations, medical debt has now risen to the top of the list of reasons why Americans file for bankruptcy. In fact, of all of the money tied up in debt collections, medical debt exceeds all other types of debt. It may be hard to believe that Americans have more outstanding medical bills than student loan bills, but the data shows it to be true.

What is a person to do when they fall ill and either don’t have insurance or need care that falls outside of their current benefits plan? The choice is simple when faced with life or death – it’s the aftermath that’s the problem.

How Can I Get Out of Medical Debt?

Firstly, it’s true that the medical billing system in the United States is filled with mistakes and flaws. Your first move should be to keep a close eye on all of your medical bills or insurance paperwork as they start arriving in the mail. If you feel there are inaccuracies,  talk to your insurance provider on the phone. Some studies suggest that between 50-80% of health insurance claims contain erroneous information or data.

Often, your medical insurance provider will be able to spot mistakes made by doctors’ offices, clearing up the problem quickly. However, there are times when people legitimately find themselves up to their eyeballs in authentic medical bills. When this happens, it is possible to negotiate with many providers to set up a payment plan that you can afford.

I Can’t Even Afford a Payment Plan for My Medical Bills!

If you’ve scoured your medical bills for errors and come to the ultimate conclusion that you ARE responsible for more than you can handle, you should know that, unlike student loans, medical debt is dischargeable in a bankruptcy.

Filing for a Chapter 7 bankruptcy in New Jersey will enable you to absolve yourself from the mountain of medical bills that you are currently buried under. At the very least, you will be able to discharge a portion of your medical debt.

Some debtors are deep in medical debt due to a spouse or child’s medical condition. In a Chapter 7 bankruptcy, not only is it recommended, but it is required to include the medical debts of your spouse and/or children on your bankruptcy paperwork. You will likely be able to discharge most (if not all) of your spouse and/or child’s medical debt.

The catch, however, is that even though you will not be liable for their debts, your spouse will still be liable if the debts were hers. Often, medical creditors don’t make a distinction, though, and your entire family’s medical debt may be erased. This is especially true if the debt belongs to your minor child, because you are financially responsible for the medical expenses related to your own children.

Consulting a bankruptcy attorney is extremely important if you are considering filing for Chapter 7 bankruptcy to discharge your medical debt. It is possible to be denied a discharge of debts due to faulty paperwork if you file on your own.

 

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