How to find medical bill errors.
Below you will find some of the best tips to follow in order to discover medical billing errors. A number of studies show that the majority of healthcare bills (insurance companies, doctors, hospitals, etc.) that people need to pay will have some type of overcharge or error on them. Find suggestions, tips, and resources which can help people find mistakes on medical as well as hospital bills.
Errors can and do occur on all sorts of bills as noted by CFPB Your health insurance company, whether it is a private insurance company or a government plan such as Medicaid, may overcharge you. Or if the medical bill is coming directly from the provider (doctor, hospital, dentists, etc.) those too can have errors. Studies suggest that up to 80% of medical bills contain mistakes. Identifying these errors could save you hundreds or even thousands of dollars.
Steps to take to identify errors in your medical bills
The first, and probably most important step to follow, is you need to ask for an itemized billing statement of all your charges. In order for this process to work you need to have that level of detail. All hospitals, doctors, insurance companies, and other healthcare providers will provide you with, upon request, an itemized hospital or medical bill that will detail the charges for all the individual procedures, tests, supplies, medications, and services.
Check for common medical billing errors. Once you have your itemized bill, review it line by line. Be methodical. Circle anything that looks odd, unfamiliar, or more expensive than expected. Heck, some medical providers even can have mistakes in your name, insurance information, or account numbers - all of which can cause major billing problems. Here are some of the other most common billing errors to look for:
Maybe the most common error is being charged for services never provided. Closely review your medical bills for services, medications, or anything else that was never received. In other words, make sure that you received every treatment, service, and medication that you were billed for. Throughout the course of your hospital or doctor visit, you need to keep a log of your treatments received, or if you can't do this, then ask a friend or family member to this while you are in the hospital.
Duplicate charges are fairly common. Being charged twice for the same service, test, or medication. This can include, but is not limited too, duplicate billing for procedures, medications, or supplies you never received.
Be on the lookout for duplicate billing, which is maybe the most common type of error. Ensure you have not been charged twice for the same medical service, supply, or prescription drugs.
Understand the terminology and basic codes. An outside resource can help. For how to help decipher the coding on your medical bill, you may want to use a third party website. Try AMA coding, which is a free medical dictionary. If you need information about a laboratory test or procedure and why it was needed for your treatment, go to https://www.testing.com/.
Another not so well known tip to find a medical billing error is to compare the explanation of benefits provided with the billing statements you received. Then be sure to cross-check the health insurance company's explanation of benefits statements with those itemized bills that you received from the doctors and hospital. Compare the medical provider’s bill to your EOB. Make sure:
Watch for upcoding on your bills, which is when sometimes charges on your medical bills can be inflated. This can occur when your doctor prescribes a generic prescription drug, but the medical bill has you paying for a more expensive, brand-name drug you didn't receive.
As simple as this may sound, verify the dates of your hospital stay or the treatments you are being charged for. Or the date you saw the doctor. As sometimes you can be charged for extra hours or days! You need to verify the dates of both your admission and discharge from the facility, and be sure you were not charged for the discharge day as most hospitals have it as their standard process that they will charge you for your admission day, but not the day you were discharged.
Errors can occur from incorrect treatment codes or patient information. Your insurance company may miscode a treatment or service provided by the doctor or even dentist. Or, in some cases, the information about the patient is incorrect, such as an error in your health insurance plan or coverage amounts.
Ensure you were not charged for canceled work. If your medical provider or doctor ordered for you, then subsequently canceled a service, or a test, or some other item that maybe you weren't able to get because you were too ill, or equipment failure, make sure you weren't charged for the canceled service.
Closely examine your operating and hospital room charges. For example, if you were in a semi-private hospital room, ensure you were not charged a higher price for a private room. Or maybe you did ask for a semi-private room but one wasn't available for you, so ensure you were not charged anyway for that private room. Also, make sure you weren't charged, or double billed, for more medication than anesthesiologist records show you received in the operating room, and ensure the same with other drugs in the hospital room.
Other common errors, whether from a doctor or hospital, include the following.
- Incorrect quantities: For example, being charged for five doses of a medication when you only received one.
- Upcoding: Billing for a more expensive procedure than the one that was actually performed.
- Unbundling: Billing separately for procedures that should have been billed as a single package.
- Canceled services: Charges for procedures or treatments that were canceled and never performed.
If you find errors, contact the billing department of the hospital, doctor, or clinic right away. Ask them to explain the charges in question. Tips for this call:
- Be polite but firm.
- Write down the date, time, and name of the person you spoke with.
- Request a corrected bill if necessary.
- Ask for a “zero balance” letter after corrections are made.
Additional resources to help identify errors in medical bills
The process and terminology is very complicated. You may need help, as many (most?) people do. Another option is to look into whether a medical bill advocate can help. They will review your bills and only charge you a percent of any savings they find. More information medical bill advocates.
Additional help is provided by a local State Department of Insurance. As most (all?) states have an insurance regulator that accepts complaints about health insurance companies and help patients resolve billing disputes. The regulator will work with patient to help Investigate wrongful insurance denials or unfair billing practices. To locate a resource, visit www.naic.org to locate your state office.
CMS - The federal Center for Medicare and Medicaid Services also has information on errors as well as tips on what patients can do. Both national and local resources are listed as noted here. https://www.cms.gov/medical-bill-rights/help/guides/bill-errors.
As noted and you can probably tell from reading above, the process is complicated. If you can't find any errors, then yet another solution is to look into whether a charity or other non-profit organization can help you with paying for medical bills or health care services. Some of these organization have assistance they can provide or at least refer patients. More on charity services that help with bills.
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