With today’s healthcare system, it is possible to get medical bills from several different doctors or facilities from a quick visit to the emergency room or an overnight stay in a hospital. Combine this with routine doctor visits and it can be a real challenge to keep up with who has been paid and who has not. Being lucky enough to have some type of health insurance plan often adds even more confusion about what might not be covered and what may be covered.
I often ask myself why medical insurance is so expensive for most people when we all have to work what seems like a full-time job to resolve issues or ensure every medical bill is paid. The price of having medical insurance just seems to keep going up each and every year. Co-pays, co-insurance, deductibles, and premiums never seem to be reasonable any longer. With a larger percentage of a person’s income going to medical costs each year, why is it so hard sometimes for providers to get medical billing correct and health insurance to cover the things it should?
One of the main reasons it can be such a hassle to deal with medical bills is due to the frequency of errors and medical coding problems. Some experts on medical bills estimate that up to 80% of them contain some type of error. Duplicate charges, incorrect patient information and even canceled tests or procedures could be on a medical bill.
Billing errors can also be due to incorrect codes being entered for treatment or diagnosis. This could result in something not being covered under a health insurance plan. Incorrect coding is something that can be quite common.
I personally have dealt with incorrect codes being entered on a hospital bill previously. A hospital bill was sent to me as the full amount owed of about $24,000. Upon doing some research and talking with the billing department they said they made an error. The incorrect code was entered for having medical insurance. Of course, the hospital just made it sound as though it was not a big deal to have this occur. They were not the person that opened the surprise bill.
Unfortunately, fraud in the healthcare industry occurs more frequently than most people realize. The Office of Inspector General with the U.S. Department of Health and Human Services investigates and prosecutes many cases each year. Physician kickbacks, inflated billing, and illegal prescriptions are just a few of the items regularly seen.
With fraud related to medical billing, upcoding and unbundling are a few of the more common practices that might be used. Upcoding occurs with a provider that lists a billing code for a more complicated procedure that pays more money. Unbundling happens when a code that could be used to put services together for a less expensive price is billed under separate codes to inflate the price.
Double billing can also happen. This results in the same bill being submitted twice when a medical procedure only occurred once. Also, in my own experience, I have seen medical bills sent to me again after a bill was already paid. In most cases, this was not a case of the original payment still being in the mail on its way, but the bill was paid months ago. I personally believe sometimes providers do this just to see if someone will pay the same bill twice not knowing one was already paid. With multiple bills being sent from a hospital stay, one that was already paid could be easily overlooked.
How can you make paying medical bills easier and ensure you do not pay more than the amount due?
Know Your Medical Benefits
It is surprising how often most people do not know exactly what their medical benefits are. If you have health insurance, it is important to know your deductibles, co-payments, and coverage. Just checking this once is not sufficient. With a plan that is renewed each year, coverage and costs could be changed. The changes are often more money and less coverage. Keep up to date on your medical insurance.
Read the Explanation of Benefits
It is common for a health insurance company to send an explanation of benefits when a medical bill has been submitted to them. Read this carefully and how it relates to the medical bill you received. The explanation of benefits will likely include:
• The amount billed by the medical provider
• Any plan discounts (this is the discount negotiated with the provider by your insurance)
• Amount of money paid by the health insurance company
• The remaining amount of money you may owe the provider after insurance coverage
The explanation of benefits provided might also include the information on what your deductible is along with your responsibility for co-payments or co-insurance. Compare the insurance benefits to the medical bill to make certain everything is covered that should be and the bill is correct.
Medical Bill Summary Only
Getting only a summary of a medical bill seems to be the norm many times for me. If you get only a summary and there seems to be a possible error on the bill, contact the medical provider and ask for an itemized detailed bill. Many times, I ask for this anyways even if the summary seems correct. Depending on the medical procedure an itemized line bill could be large. It is definitely worth it to get a line item bill in this case. The more things that were done the more chances for errors. If a large amount of money is due for a medical bill, it could be worth the research time.
With a detailed bill, it will take some time to discover any issues. You will need to research all of the billing codes and charges to ensure they are correct. Just doing a simple Google search can help find codes and sometimes issues associated with them. A site like this one https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx can also help. It is a Medicare code lookup website. Don’t use the prices if you don’t have Medicare since these can sometimes be negotiated differently. Just use the site to see what the codes are. An ICD code reference site can also be used to make sure any diagnosis is being billed correctly.
What can you do if you find an error on a medical bill?
Finding errors on medical bills occurs more frequently than it should. It is not always an easy process for resolving them. However, there are some steps you can take to get issues resolved.
Contact the Medical Billing Department or Provider
If you do see an error on one of your medical bills, reach out to the provider of the billing department. Hospitals will often have an entire department for this purpose. Explain the issue on the bill to get it corrected.
In the case of a hospital bill if the error does not seem to get resolved, reach out to the providers patient advocate. Larger hospitals will often have them. Patient advocates are there to help get things resolved.
File an Appeal with Your Insurance Provider
If the error on one of your medical bills looks to be something that your insurance carrier paid out on and paid more than they should have, it is likely they will fight to get the issue resolved. They will do this because it will save them money. Insurance companies do not like to pay more money than they need to.
Contact Your State Insurance Department
When you can’t get anything resolved with a provider’s billing department, your own insurance company, or a patient advocate it is time to contact your state’s insurance department. Insurance is regulated by each state. Contact the insurance department for your own state. There will be some paperwork to fill out for an issue to report it.
Get Your Own Legal Help
Getting your own legal help for a medical bill issue should be your last resort and it will likely depend on the amount a provider says you owe. Your own legal representation for fighting medical bills will be costly. I can’t say for certain because I have never had to go this far, but having to obtain your own legal help would seem to be a rare occurrence. Following the previous paths mentioned to resolve medical bills usually corrects an issue before getting this far.
Keep Good Records
It is particularly important to keep good records when it comes to paying medical bills. Come up with a filing system of some kind. I personally use a binder for each medical bill during a year. If a question comes up on a possible error, note the date, time, and person you spoke with.
When paying a medical bill always get a receipt. I personally prefer not to pay in cash. Use a check, Health Savings account credit card if you have one, or even a credit card as the last option. This way there will be a record of payment even further than just receiving a receipt.
Some of my medical bills that come in the mail can only be paid if mailed in or in person. When mailing in a bill it is especially important to make a payment on something that is traceable. The good news is that many medical providers now have a payment method that can be made through an online portal. These are a good option for me because I immediately get proof by a receipt and confirmation for payment.
Don’t Be Afraid to Question Costs
It is very possible that at some point in time you may see the same medical treatment being charged at a different rate from a different provider. If an expense seems like it cost quite a bit more than you were previously charged at another medical facility, question why. It could be an error or another medical facility may just charge more for the same thing. Although this may not ethically be right, it isn’t necessarily illegal. Some medical providers just charge more than others.
Making Any Form of Payment Myth
I have always heard from people that making some type of payment on a medical bill will prevent it from going to collections. This is simply not true. Just like dealing with a debt collector when a medical bill does go to collections, you always need to get it in writing that a medical bill will not be sent to collections if payments are made.
The good news for medical bills going into collections is that Congress passed the Medical Debt Relief Act in 2016. This was an amendment to the Fair Credit Reporting Act and Fair Debt Collections Act. If a medical bill goes unpaid into collections, the person must be notified by the collection agency that the account was placed in collection. The person then has 180 days from the notification to pay the amount due before the collector is allowed to report the collection to credit bureaus. It also made it so a paid medical bill collection must be removed from a person’s credit report within 45 days once the amount due is paid.
Dealing with medical bills can be a really big hassle. I know for me each time either I or someone in my family goes to the doctor or has a hospital visit the anxiety of the medical bills always comes to mind. It seems like it is almost always a roll of the dice if all the billing will be correct. This is in addition to my health insurance provider covering everything correctly. Because a patient is typically not going to question the need for something in most cases, there is never a way to absolutely know everything that will be covered by insurance.
It is important to try and make the process of paying medical bills as easy as possible because medical providers and health insurance companies are going to make billing mistakes. Most experts agree that some type of error on a medical bill occurs almost 80% of the time. You need to know your medical coverage and benefits. This is the first step in being able to spot possible medical bill errors. It can take some time to research billing problems. But following some guidelines and learning what to look for can make the stress much easier when it comes to paying medical bills.