How to Spot Medical Bill Errors and Dispute a Medical Bill
February 7, 2024
Everyone makes mistakes every now and again — including medical providers and insurers. Medical bills can contain all kinds of errors for a variety of reasons. The actual medical provider could code a service incorrectly, the billing department could have a mixup, or even the health insurance company could get something wrong. But just because someone else made a mistake doesn’t mean you (or your clients) have to pay for it.
In today’s blog, we’re sharing how to spot common medical bill errors and how to dispute the incorrect charge(s).
Common medical billing errors
Some are honest mistakes while others are blatant attempts from hospitals to get more money. Either way, the best way to catch medical bill errors is to ask for an itemized bill. Sometimes simply asking for an itemized bill can correct mistakes and lower the overall medical bill. Once you receive the itemized bill, carefully review it for some of the most common errors below.
This is a simple mistake, but depending on what gets charged twice, could make a bill very expensive. Review the bill carefully to make sure you were not billed twice for a single service or procedure.
Canceled tests or procedures
It’s entirely possible to be charged for something that was scheduled but then got canceled. Canceled tests and procedures could be easily forgotten to be removed from a medical bill. If you think you or your client were wrongfully over-billed, collect all the necessary documents to prove that you did not receive the service so you can dispute the charge.
Incorrect patient information
Errors such as incorrect name spellings or policy number misprints are common on medical bills. If the insurance ID number is wrong, it can lead to a claim denial or a full amount sent out by your health plan. These mistakes may seem small, but they can cause huge headaches and a far more expensive bill than you or your client should be getting. If you see an incorrect insurance ID number or incorrect name, contact the provider and your insurance to correct the issue.
This one isn’t so much an honest mistake as a blatant attempt for a provider (usually hospitals) to get more money. Upcoding is when a provider inflates a patient’s diagnosis to one that represents a more serious procedure. This of course leads to a higher medical bill. For example, you could have received the lowest level of emergency room services but be billed at the highest level. This is an illegal, fraudulent practice, so if it happens to you or your client, ask your healthcare provider to correct the charge immediately.
Unbundling of charges
This refers to the separation of charges that should have been billed under the same procedure code. This type of mistake can be tricky to identify unless you’re a certified medical bill coder. Still, you can reference CMS’ National Correct Coding Initiative tools to more easily identify these mistakes.
Balance billing when in-network
A recent ruling from CMS has banned balance billing (the No Surprises Act), but unfortunately, it can still happen. Balance billing is when the healthcare provider bills you for charges other than co-payments, co-insurance, or any other amount than what was assigned by your insurance company. Balance billing often happens due to part of medical care being out-of-network. For example, someone receives surgery at an in-network hospital, but it turns out the anesthesiologist who was working that day is employed by a third-party company and therefore out-of-network. Balance billing is no longer prohibited by CMS, so if you think you or your client has been balance billed, compare the bill with your Explanation Of Benefits (EOB) to make sure.
Similar to duplicate charges, sometimes an incorrect quantity is billed to people who received medications, bandages, or other medical items while under a provider’s care. This mistake could be as simple as an extra “0” placed at the end of a number by the billing department. Once again, you’ll be able to catch these kinds of mistakes by asking for an itemized bill.
Operating room and anesthesia time
If you or your client underwent surgery, check your medical records to see how long you were in the operating room or under anesthesia. Because patients are usually billed in 15-minute increments in these instances, mistakes here can add up quickly.
Steps to dispute a medical bill:
Contact the provider
In order to dispute a medical bill, you’ll first need to contact the provider. Ask them to explain any errors you found, and request that they correct the bill.
Contact the insurer
If a claim has been submitted, contact the insurance provider to help resolve any billing issues. If a claim ends up being denied, file an appeal with the insurance company to get another review.
File an appeal with the insurance company
This process will vary depending on who the insurer is. The first step is to visit the insurer’s website or your member portal to find the documents needed to start the appeal process. You can submit additional documents as well if you think it will help your case, such as a letter from the medical provider. According to CMS,
“You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied. If you have an urgent health situation, you can ask for an external review at the same time as your internal appeal.
If your insurance company still denies your claim, you can file for an external review.”
CMS also recommends the following documentation when filing an appeal:
- The EOB forms or letters showing what payments or services were denied.
- A copy of the request for an internal appeal that was sent to the insurance company.
- Any documents with additional information sent to the insurance company (like a letter or other information from your doctor).
- A copy of any letter or form you’re required to sign, if you choose to have your doctor or anyone else file an appeal for you.
- Notes and dates from phone conversations you have with your insurance company or doctor related to your appeal. Include the day, time, name, and title of the person you talked to and details about the conversation.
- Keep your original documents and submit copies to your insurance company. You’ll need to send your insurance company the original request for an internal appeal and your request to have a third party (like your doctor) file your internal appeal for you. Make sure to keep your own copies of these documents.
If necessary, you or your client can also request that your state’s Consumer Assistance Program also file an appeal. Not every state has this program though; you can see which states do and do not have Consumer Assistance Programs here.
Finding errors on a bill can be upsetting and it might seem daunting to dispute the medical bill, but it’s well worth it. Especially since these errors can lead to unnecessary costs and put a strain on financial plans. As a comprehensive financial advisor, you can support your clients through medical bill errors and disputes. This will not only protect the financial plan you’ve put in place, but will also increase the trust and confidence clients have in you. The good news is that most providers are willing to correct billing issues, and having them on your side can be a big help when you go to the insurance company. Going up against an insurer can be frustrating, but if you have all the right paperwork and are patient, there’s no reason that errors on a medical bill won’t be fixed.