80% of Medical Bills Have Mistakes? Review Tips and How to Fix Errors
9 minute read
When you get that hospital bill, it might feel like the shock of it alone could give you a heart attack. If you’re thinking, “this can’t be right” you might be correct.
According to the Medical Billing Advocates of America, up to 80% of medical bills contain errors. This means the chance of your medical bill being incorrect is much greater than the chance of it being correct.
Why Are There Mistakes on My Medical Bill?
It just doesn’t seem right that there can be so many medical bill mistakes out there. There are a lot of parts that go into a medical bill: for records, for insurance, and for the patient.
Medical errors can range from simple and fairly easy-to-fix mistakes to big gaffs that can cause the insurance company to deny payment and dump a huge bill in the patient’s lap.
Patient data typo: The people who enter your information are just human and can make mistakes. Your handwriting might be a little difficult to read, too.
These are simple mistakes. like a misspelled name or inverted numbers in an address/phone number. Any little errors like this do happen and typically are easy to correct.
Outdated information: You could have outdated information in your file that you simply forgot to update. Do you have a new address, new emergency contact, perhaps a new last name due to marriage or divorce? All of these things can lead to a small error in your bill and/or medical record.
Coding errors: The medical field is filled with codes. In real life, trying to match symptoms, illnesses, and individual lives up with medical codes doesn’t always make sense, but in the medical field, it’s essential if you want to have your insurance cover the costs.
From CPT codes, HCPCS codes, ICD-9 codes, and more, there are a lot of places where errors can occur.
Duplicate charges: This is another reason to carefully review your medical bills. Too often, charges are entered more than once. Stay on top of this common error, and you should be able to easily resolve it.
Cancelled or refused care: If your doctor ordered a round of tests and then they were cancelled, or you decided not to follow through, they could still be passed to the billing department. Tests can be expensive, so it’s in your best interest to look for errors and then dispute any charges.
Unbundled charges: This is tricky, but sometimes a group of charges should be billed under the same procedure code, as there is a financial discount. These are bundled medical charges.
Think of it like your cable, internet, and phone bill—when billed separately, it’s more expensive than the bundled fee. It might take professional help to determine if your healthcare provider is charging you individual fees when there should be a bundle discount.
Network errors: The way insurance is set up these days is very confusing. Each insurance has different networks, the networks offer different discounts with co-payments and co-insurance.
The list of differences between how one insurance carrier is handled versus another goes on and on. This is where understanding your plan is key to making sure you’re billing charged accurately.
If you don’t feel comfortable finding errors on your medical bills, it’s a good idea to have someone help you review them to make sure there aren’t any errors. If you don’t know who to ask, a friend or family member might be able to help, or you can check with a patient advocacy group for assistance.
Fortunately, there are often many different people within your healthcare team that can help you make sure there is an error. They might even have a path to the solution you want, too.
Here is who to contact and why:
♦ Your provider’s billing office: The medical billing office can help you determine if you’re actually seeing an error or not. They can also explain your bill in greater detail.
♦ Your doctor or healthcare provider: Sometimes it’s best to speak with your doctor or their nurse to make sure you understand the procedures you had performed.
♦ HR department at work: If you have employer provided insurance, the human resources department can help you understand your insurance policy, the benefits, and payment structure.
♦ Insurance carrier: Oftentimes, the insurance carrier has information to help you understand the charges and payments on your bills.
What to Do About Medical Bill Errors
So, you’ve discovered an error on your medical bills, now what? As all medical billing mistakes are different, the process to get them corrected can be vastly different.
The following suggestions are ways you might be able to remedy the mistake, but by no means is any one of these tips guaranteed to be your solution. Sometimes it just takes a lot of persistence to get the results you want.
Get an itemized bill: If you haven’t already, you’ll need an itemized statement from your healthcare provider to fully understand your bill. Fortunately, most doctors provide this automatically.
Contact the medical billing department: If your doctor’s medical billing department made an error, big or small, the first step should be to contact them and let them know you think an error has been made. If it’s a simple problem, this might be all the action you need.
Contact your insurance: If you feel the insurance company actually made the error or if you’re having trouble getting your healthcare provider’s office to cooperate, it’s a good idea to let your insurance know what’s happening.
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Gather your documentation: If you know there was an error, it’s time to prove your case. Ask your healthcare provider for copies of your medical record to backup your position. Cross reference your record against your bill to detail treatments and charges.
File an appeal: If you’re not getting the help you want, and your insurance is denying the bill, it might be time to file an appeal with your insurance. This gets the ball rolling and lights a fire under the insurance company to look into any charges made in error.
They certainly don’t want to pay for a procedure you didn’t have or pay twice for a service you only incurred once.
Meet with the patient advocate: Depending on the healthcare provider, there might be a patient advocate who can help you get the resolution you want or can help you understand your bill better.
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Find legal help: When things are really spinning out of control and you find yourself in one of those situations where nothing is working, an attorney who specializes in this type of law might be your best answer. Remember, these highly-trained professionals can be very expensive, so you’ll have to weigh your options here.
The Bottom Line
One key thing to do, across the entire process, is documenting everything. Start a journal of all the dates you spoke with people, the names of the people you spoke to, and take notes on what they tell you.
Obviously, if the error is a simple spelling mistake in your name, this isn’t necessary. However, if you have a more complicated medical error problem, you’ll be thankful you were this diligent. Also, preventative medicine is always cheapest, so doing things at home to, for example, fight off colds and the flu, can be extremely cost effective.
Medical errors are an unfortunate and frustrating reality, so a pragmatic approach is essential.
