DISPUTE A MEDICAL BILL AND REDUCE YOUR PAYMENT.
By Robert Farrington, The College Investor.
When disputing a bill, it’s important that you do your research and understand what happened and what’s going on. That way you can help troubleshoot the problem without passing blame. Customer service reps will be much happier to work with you if you adapt this approach.
Second, realize that mistakes will happen. Even if 99.999% of medical bills are done correctly, there will still be errors. People still process these. Be sympathetic up front to this.
Third, take diligent notes of all your conversations and encounters throughout the process. You should record conversations if possible (and allowed), and get things in writing. At a minimum, I recommend:
- Date and Time
- Who you spoke to (first and last name, ID number if possible)
- Details of the conversations
- Commitments from the company/individual with specific timelines to follow up (i.e. When can I expect this to be resolved? When should I follow up if I don’t receive anything?)
- If on a cell phone, screenshot your phone at the end of the conversation to highlight the phone number you called, and the length of time you were on the call. If you can’t do this, keep your phone statement with the call.
If you’re mailing documents or doing any written correspondence, I recommend:
- Ensuring you keep a copy of everything you send, with date mailed
- Send all mail certified mail with return receipt – put the return receipt with your copies of what you sent so you have proof they received it
Finally, when disputing a bill, it’s important that you ask about the due date of the bill. You want to ensure that collection on the bill is paused or suspended while the bill is being disputed. If they don’t do that, ask that the due date be extended out a period of time.
The bottom line is you don’t want this company to send you to collections while you’re disputing their bill.
Step 1. Review Your Bill & Explanation Of Benefits
The first thing you get (typically before your medical bill even arrives) is your explanation of benefits from your insurance company. I would venture that 95% of people throw these away and don’t even know what they are for.
Next, your actual bill will come in the mail.
It’s so important that you review BOTH your medical bill AND explanation of benefits. This could be the first sign of something wrong.
First things first:
What Is An Explanation Of Benefits?
The Explanation of Benefits is a document provided by your insurance company the explains your insurance benefits as it pertains to a bill.
While every company lays out their Explanation of Benefits differently, you will usually see something like the following:
- Amount Billed By Provider (this is how much the doctor or hospital charges)
- Plan Discounts (this is a discount negotiated by your insurance company)
- Amount paid by insurance company
- Amount you will owe the provider
Most explanation of benefits forms will also include information about your deductible, co-pay, co-insurance, and more.
If a procedure is not covered, the explanation of benefits will also typically have a code or error, with a short explanation as to why it’s not covered. To get more information, you typically have to call.
Here’s an example:
How Does An Explanation Of Benefits Compare To Your Bill?
Now that you understand what the explanation of benefits it – you need to compare it to your bill. Your bill should exactly match the explanation of benefits. This could be your first sign of an error!
In some cases, I’ve seen medical bills that forget to apply the “plan discount” and so the patient is billed a higher amount than the Explanation of Benefits states. This is why it’s essential that you compare the two.
Some companies may combine multiple bills into one. However, if you receive your EOB and your bill, and you believe something is wrong, you need to get a more detailed picture.
Step 2. Get A Detailed Line-Item Bill
Once you’ve gone over your Explanation of Benefits and Medical Bill and you believe there is a problem, you need to request a detailed line-item bill. You can typically do this by calling the medical billing department listed on your statement, or in some cases, you can go online and print it.
What you’re looking for is a detailed bill that lists out everything:
- Date and Time
- Medical Billing CPT Code
- Total Price
- Insurance Adjustment
- Patient Amount Due
When you have a procedure done, you can have a LOT of billing codes for the same event. If you have a hospital stay, the list could be huge.
But it’s on this list that you’ll be able to spot any errors in billing. The CPT Billing Code is key. To review your bill, you want to search for the billing code listed on your detailed bill.
For example, CPT Code 85025 is a blood test to check white blood cell count and more. There are multiple websites that allow you to search CPT codes, but I’ve found Google search to work best. Especially because it will find discussions around these codes for medical billing issues.
In my case, it’s where I discovered I was billed for the wrong procedure. I was billed for Ulna Surgery, when I didn’t have a surgery, but just an examination. There was a 1 digit error in the code which resulted in a 10x medical bill.
However, just finding the error is only the start of your medical billing dispute.
Step 3. Call The Medical Provider Billing Department
Once you’ve figured out what the issue is, it’s time to start making some phone calls. The first stop is simply calling the medical billing department’s customer service line and talking to them.
I know this sounds crazy, but you have to start here. So many people want to jump to lawsuits, when they haven’t even started to address the problem with people who can potentially fix the issue.
Depending on the issue (either incorrect billing or a price dispute), you will want to take one of two approaches.
In the case of an error, simply tell the representative that you’ve found an error and would like to dispute it. Ask what the process entails.
Typically, the customer service agent will tell you:
- They will put in a request for their team to research the issue
- They will put your bill on hold while they research the issue
- They will give you some type of timeline to hear back on the request (typically 4-6 weeks)
Going back to the beginning of this article – make sure you document this in detail. Confirm with the agent what part of your bill is on hold – is it the total balance or just the disputed item. If it’s just the disputed item, you need to make sure you pay the rest of your bill on time.
If you’re simply calling to dispute a price or total amount of the bill, the customer service agent may be able to help you.
When I first called the billing department to dispute the price of the CT scan, I made it come across as this was a burden to pay double what I had previously paid. Without even skipping a beat, the agent on the phone said she could immediately reduce my bill by 20% if I made the full payment on the phone with her.
From doing my research on this article, this seems to be a fairly common practice with medical billing. In exchange for something immediately, most companies will offer a serious reduction in price.
However, just like every call center and customer service center, medical billing departments have supervisors too. And if you can speak to a supervisor and explain your story a bit, you might have better luck securing a bigger discount on your medical bill.
For my story, I was able to get them to match the price of the procedure, effectively giving me a 50% reduction on my medical bill.
Step 4. File An Appeal With Your Insurance Company
If you’re covered and using your insurance to pay for a medical procedure (or at least part of it), a great way to make progress on disputing your medical bill is to also file an appeal with your insurance company.
This can really work in your favor if there is a medical billing error (like I had with the ulna surgery that never happened). You see, your insurance company doesn’t want to ever pay more money than they have to. If you discover an error, even if they’ve already paid it, they might be incentivized to go back to the medical provider to resolve it as well.
That helped me a lot in my case. My insurance company still had to pay more money than they should have when it came to my broken wrist. They opened a dispute on their end, after I had opened a dispute on my end.
If you were incorrectly billed for a procedure and not only are you having to pay a lot of extra money, but your insurance company is too, they will want to know about it. And, it could help you get the entire situation resolved.
Step 5. File An Appeal With Your Medical Provider’s Patient Advocate
Depending on your medical provider, they may have a patient advocate that could help you reduce your bill, help expedite resolution of errors, and more. Patient advocates are usually found in hospitals and large medical provider networks (like HMOs) that serve a lot of patients.
These people are exactly what they sound like – people who advocate on behalf of the patient. If you’re not getting resolution (or things are taking longer than promised) with the billing customer service department, getting a patient advocate involved can be very helpful.
Patient advocates are also typically empowered to give discounts to bills as well. Even if it’s not error related, they could help in times of hardship. They also have great connections to resources that can also help you if you can’t afford your medical bills.
Step 6. Contact Your State Insurance Commissioner
The next step if you can’t find a resolution to your medical billing dispute is to loop in your state regulators. Insurance is handled at the state level by a State Insurance Commissioner. While laws vary from state to state, most states have departments that are willing to help consumers in their states navigate the complexities of health insurance.
When you contact your state insurance commissioner for disputing a medical bill, it’s essential that you have all of your paperwork and documentation in order.
You will typically need to fill out an official complaint form, and you can then attach your own documentation to support.
If there is a true medical billing error not being resolved, this is where you can clearly state the error, the CPT codes that were inaccurate, what the codes should have been, and the potential estimated difference in price.
If your claim is simply being denied by your health insurance, this is also the appropriate place to dispute that request. In some states (like California), there is a specific request for an Independent Medical Review to determine if you should be covered.
Step 7. Consider Legal Counsel
Finally, the last step, if you’re still not getting resolution on your medical billing dispute is to seek legal counsel. You will want to find an attorney that specializes in medical billing disputes.
Most attorneys will do a free call to determine if they can even be of assistance to you and if you potentially have a case. They will also tell you what the costs might be. It could get expensive.
To find an attorney:
- Contact your state bar association for a referral (many state bar associations have referral services)
- Search for attorneys on a platform like Avvo, which has attorney profiles. Avvo also provides a record of client reviews and peer endorsements, which can be helpful in selecting an attorney.
- Once you find an attorney you might want to work with, cross-reference the attorney with your state bar association to see if that attorney has any record of public discipline.
- Do a Google Search of that attorney to see if their name comes up in a good way (for example, through press or publications) or in a bad way (such as being sued by a government agency or regulatory body for misconduct).
Disputing a medical bill and reducing your payment can be stressful and frustrating. Navigating a complex bureaucracy, having the threat of creditors coming after you if you don’t pay, and simply the time it takes to get anything done make this one of the most unpleasant experiences a consumer can face.
I wanted to share a few reminders though.
First, don’t worry about your doctor. In many cases, doctors don’t get involved in billing at all. They don’t know if you paid or didn’t pay. And they aren’t suffering from you not paying your bill. Realize that your doctor’s number one priority is simply your health.
Second, don’t worry about your credit report. These disputes take time (a lot of time). And in some cases, you might see your bill turned over to creditors or reported on your credit report. Luckily, the laws have been changing in consumers favor. Last year, new rules made it so that medical debt cannot be posted to a credit report until it’s at least 180 days past due. And if it is paid and/or resolved, it must be removed from the report.
So, if you’re disputing your medical bill, don’t let your medical provider hold your credit report over your head.
Last Updated On
Four tips to help you fight back against high medical bills
“Will your practice take my insurance?” is the wrong question to ask your doctor. More than 20 states have legislation to protect users from “balance billing,” or out-of-network costs that can run into the thousands.
That’s because, even with coverage, individuals run into higher costs in the form of high deductibles, out-of-network fees and additional expenses related to testing that may not be useful.
Yet there is more to paying for medical expenses than just footing the premium for your policy.
Health-care plans will look the same, but if one costs more, often it’s a difference in the network that’s covered. A lower cost plan has a narrower network, but you will pay out of network costs if you go elsewhere.
These are the levers you can use to manage your expenses.
1. Ask questions
It’s no longer enough to ask your doctor’s receptionist, “Will you take my insurance?”
“When you’re making an appointment, don’t ask if you’re covered under your plan,” said. “Everyone will take your insurance.”
Your doctor’s office may accept your insurance, but that won’t spare you from a surprise bill weeks later if he or she is out of your network, McClanahan said.
The correct question for your doctor’s receptionist is, “Are you in my network?”
Be sure to document who gave you the answer and the date so that you’re prepared to fight back if you get a bill that says otherwise.
Speak up when your doctor recommends tests and prescriptions. Ask questions such as: “Is the testing facility in-network?” or “Are the doctors evaluating the tests in-network?”
Don’t be shy about asking your doctor for an explanation if he or she recommends that you undergo a test. Learn more about the test and find out how the results will affect the approach to treatment.
“If they can’t provide a clear answer, ask, ‘Is this test really necessary?’” said McClanahan.
Finally, curb costs on prescriptions by asking whether your medication is covered under your plan and if a cheaper version is available.
Sometimes it’s cheaper to pay cash for your medication than to claim it on your insurance, McClanahan said.
She suggested digging up drug price information on GoodRx.com and comparison shop.
“Know the benefits and risks, how long will you be on medication, and what are the alternatives to the medication prescribed,” McClanahan said.
2. Know your coverage
Understand what your policy covers, including the details on out-of-pocket maximums, deductibles and co-insurance.
Get familiar with your state’s laws against “balance billing” – a practice in which insurers only partly cover an out-of-network cost and leave consumers to pay the remainder, which can be thousands of dollars.
More than 20 states have some kind of legislation on the books to protect consumers from balance billing, according to the Commonwealth Fund.
When you are admitted to the hospital in the event of an emergency, write on all of your paperwork that you will only permit in-network care, said McClanahan. Be sure to take a photo of this document or make a copy of it.
“Once you get the bill, if they charge you for out-of-network care, you have ammunition,” McClanahan said.
3. Reach out to your regulator, if you must
If balance billing is illegal in your state and you receive a massive out-of-network bill, be sure to reach out to your doctor first, as it may be an error. Pull in your insurer to help.
If neither your doctor nor your insurer will help you address the bill, then it’s time to contact the regulators, said McClanahan.
That means you should reach out to your state medical board and your state’s insurance department.
If your insurance plan is self-funded – one in which your employer assumes the financial risk for providing your health-care benefits – then you should contact the U.S. Labor Department’s Employee Benefits Security Administration.
4. Document everything
Maintain a health-care log so that you’re equipped to fight back in the event of a dispute with your insurer. Keep track of any communications you have with your insurance company and your doctor.
If needed, hire an expert to act as your advocate, McClanahan said. She suggested reaching out to the Alliance of Claims Assistance Professionals.
Big Hospital Bill? Negotiate!
By Gerri Detweiler – Credit.com.
Brett Goldstein is used to dealing with big numbers. After all, he runs a pension service company. But nothing quite prepared him for the shock of the medical bills he received after his daughter broke her leg and spent less than 24 hours in the ER. The total tab? Around $30,000.
Although Goldstein had health insurance, his daughter had broken her leg in a fall on someone else’s property, and their insurance would pay the bills. All he had to do was forward them to the property owner’s insurance company. That twist, though, led Goldstein deep into the complicated world of medical billing. If he hadn’t forwarded them,”the bills would have gone straight to my health insurance company,” says Goldstein and he probably wouldn’t have discovered that the hospital had made billing errors. Even though the charges would be covered by insurance and thus wouldn’t come out of his pocket, he dug in, questioning every item.
“I was double billed. I was billed for things (my daughter) didn’t receive,” he says. “Some of these charges were ridiculous.” Twenty minutes in the operating room, for example, resulted in a $7,400 charge. ”I have an $800 anesthesia bill from the hospital but they don’t provide anesthesia,” he says, noting that he also received a separate $1,800 bill from the third-party anesthesiologist who did provide that service.
Goldstein, who has also written a book about retirement, developed a list of steps patients can use to challenge and negotiate
medical bills. (see the 10 step process below).
Among the most important: Request your medical records. (You may have to pay a small fee for copies.) The medical records include information like doctor and nurse’s notes, the medications you were given, and notes about your care. Then request forms UB-04 (typically used for hospital, rehab or surgery center or clinic bills) and/or CMS 1500 (typically used for doctor’s bills).
Goldstein explains that the UB-04 is what the hospital uses to bill the insurance company. It lists what department generated revenue from the patient. He warns that it may not be easy to get these forms. “The hospital doesn’t necessarily want you to see this because if you matched up the codes with the medical records, you’ll be able to find mistakes,” he says. He provides a sample letter to send to the hospital demanding the forms (below). He explains: On the CMS-1500 there are two sets of codes you’ll be looking at. The first code is the CPT code which is used by insurance companies to determine the amount of money they will pay a doctor or hospital. The other code is an ICD-9 code, which tells you what type of injury or illness you had.
“If the codes don’t match with your medical records, you have found a mistake,” he further explains. His daughter’s bill listed code 72170-26—the CPT code for an X-Ray of the pelvis. But her records listed ICD-9 code 821.01, indicating that they fixed a fracture of the femur.
With medical records and billing codes in hand, you can challenge mistakes. A simple web search can help you find out what various codes mean.
After you’ve disputed errors on the bill, the next step is to find out what the services you did receive actually cost. Goldstein says the UB-04 will list a code that states what Medicare would pay for that service. You can use that information to negotiate more reasonable charges for the services you received.
Goldstein recognizes that not everyone has insurance that will cover large doctor or hospital bills. He encourages them to make sure their bills are accurate before they start negotiating payments or discounts. ”Everyone says to negotiate medical bills,” say Goldstein. “But I’d rather get the bill down in the first place (by challenging mistakes) and then negotiate.”
Here’s the 10-step process to lower your hospital bill:
1) REQUEST AN ITEMIZED BILL: You can get a copy of your itemized bill by calling the hospital billing department. The itemized bills showed all of the charges my daughter incurred and on what dates they were given.
Generally you have to be careful as the hospital billing department generally doesn’t handle the doctor’s billing. The doctor you see at the hospital charges separately from the hospital and it’s handled by a different department. So make sure you call both the hospital billing department and the doctor’s billing department. Make sure you also ask about the anesthesia billing department. Sometimes the anesthesia billing department is separate from the doctor’s billing department.
2) DETERMINE FINANCIAL RESPONSIBILITY OF THE INSURANCE COMPANY: The next step is to call the insurance company, if you have one, and find out what they paid, how much they paid, and when they paid it.
3) BE YOUR OWN PATIENT ADVOCATE: Take down the name, the date, and the time you speak with people. You must get full names from everyone you talk to, the date you spoke with them, the time you spoke with them, and what was said. If available you should also get any employee ID numbers or sometimes hospital and insurance companies will give you a confirmation number for the call. As most calls are recorded, this gives the hospital or insurance company a reference number, in case they have to go back and review the taped conversation. This is a crucial step in holding the hospital and or the insurance company accountable for their actions. Create log sheet and log in every call and even take notes of what was said. This may help you later.
4) REQUEST YOUR MEDICAL RECORDS: By requesting the medical records, you can check to see if the hospital charged you for something that the doctor never authorized. Or maybe they over-charged you. Getting you own medical records is easy. You just have to write to the hospital and request that your records be sent to you. They usually charge between .75 and $2.00 for each page. If the medical records are too big (too many pieces of paper) you may have to pay in advance. Or they may offer the option to get an electronic copy at a lower charge. If the records are small, they will send you the records along with a bill. However if you are requesting someone else’s medical records, then that person will have to fill out a special form that authorizes you to get the medical records.
5) REQUEST FORM UB-04 (formerly UB-92) or CMS 1500: The UB-04 claim form is used by hospitals to get reimbursed by insurance companies. Some people still refer to it as a UB-92 form (the UB-92 form was updated and is now the UB-04 form).
Hospitals, rehab centers, surgery centers, clinics, and other facilities need to bill their services on the UB-04 form in order to get paid by an insurance company. Physicians on the other hand, bill insurance companies on a CMS 1500 claim forms. By looking at the UB-04 or the CMS 1500 you will see what billing codes were used. Billing codes provide insurance companies and you with what type of illness and how it was treated. There are two sets of codes you will need to learn. First code is the CPT code. This code is used by insurance companies to determine the amount of money they will pay a doctor or hospital. The other code is an ICD-9 code, which tells you what type of injury or illness you had.
The bill you receive from a doctor or hospital has the CPT code to tell the insurance company how much to pay the doctor and the ICD-9-CM codes to describe what was wrong with you.
Reviewing the codes is important as there are many codes that should not be billed together. For example, you should not have a code for a Pelvis X-Ray when you see code ICD-9 830 as that is the code for a Dislocated Jaw. Sometimes insurance companies won’t pay a claim if the wrong codes are used. This is why it’s important to check the codes. You can go to Wikipedia https://en.wikipedia.org/wiki/List of ICD-9 codes and look up all of the ICD-9 codes. You can also look up all of the CPT codes at Wikipedia. https://en.wikipedia.org/wiki/Current Procedural Terminology
The UB-92, UB-04, or CMS 1500 is not always easy to get. You may have to write a letter to the hospital demanding it.
Here is a letter that you can use to request form UB-04 (or CMS-1500):
[Institution Name] [Institution Address] [Institution City, State, ZIP] [CFO Name]
Re: [Patient Name], Account [Patient Account Number], Date Admitted [Admittance Date]
Dear Mr. [CFO Name]:
I am writing to request your full and thorough review of my account. I received your balance due notice indicating I owe $(Amount Due) on the account. Please be advised that I do not believe the charges to be a reasonable price for the services rendered.
I am exercising my rights under HIPAA and demand that you provide me with a copy of the (UB-92/UB-04 or CMS-1500) used to make decisions on my behalf and made part of my designated record set. Under federal law (HIPAA), I am entitled to, and I am demanding a copy of the financial responsibility agreement and principle admitting, diagnosis, and treatment codes within 30 days of receipt of this letter. If you fail to provide either document, I will file a complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services and forward my complaint to the U.S. House Oversight and Investigations Subcommittee.
I personally have a right by law to receive this information from you. I expect you to comply. The requested information should be sent to my attention at the address below. I will pay for any reasonable copy cost associated with this request. Thank you for your prompt assistance with this matter.
6) KEEP COLLECTIONS DEPARTMENT FROM PURSUING FURTHER PAYMENT: If you can’t get the problem resolved before the bill is due you should pay the part of the bill that you are not disputing. You should also keep an eye on your credit reports if you can’t resolve the matter within 30 days. After 30 days, the hospital or doctor may report you for not paying your bill and put you into collections. If you check your credit report and you find out that the hospital or doctor reported your bill as unpaid, you will then need to write to the credit bureaus and explain the ongoing dispute. The bureaus must review your complaint and correct your report.
If you are put into collections, you should write the collection agency a letter disputing the bill. According to the Fair Debt Collection Practices Act, a collector may not contact you if within 30 days of being notified, you send the collection agency a letter stating you do not owe money. However, a collector can renew collection activities if you are sent proof of the debt, such as a copy of a bill for the amount owed.
7) REVIEW MEDICAL RECORDS TO CHECK FOR ERRORS: The next step after you receive the medical records is to compare it to the itemized bill. You should look at the itemized bill and make sure that every charge was authorized by the doctor. Did they charge you for a test the doctor never instructed the nurses to do? You need to look at medications. What medications did the doctor prescribe and how many times did you take the medication? Maybe the hospital charged you for medication you never received? Maybe they charged you for too many doses? Look at you hospital records and count the number of times you actually took the medicine.
Other things to look at are charges that take place after you have been discharged, or that take place before you are admitted. Also look at items that have been billed twice and question anything on the itemized bill that looks exorbitant.
Also whether you are at the hospital or the doctor, some things need your authorization. While most doctors and hospitals are good at getting your authorization, some forge your name. That ‘s right. Some doctors bill the insurance company for tests that you may or may not have received. Before the insurance company pays, they need to know that you authorized the test or procedure.
Some doctors just write down “SOF”, which stands for Signature On File. In some instances a doctor will say that the test or procedure was done and write down SOF on the insurance claim form. Again in many cases the doctor or hospital does have your signature on file and you may have signed the authorization form. However there are those doctors that are looking to defraud the system and collect money by stating they did tests when they never did. All they have to do is write SOF on a form. This is why its important that you get the medical records, so you can make sure that you signed the form and no one put down SOF. If you didn’t authorize it, it can’t be billed to you.
8) DETERMINE THE COST OF SERVICES: There is a standard for determining the cost of services. Simply calculate what Medicare would reimburse for each item. The UB-92 or UB-04 will give you a code and that code will tell you what Medicare would pay.
9) CALCULATE FAIR AND REASONABLE CHARGES: There is an industry standard for calculating fair and reasonable charges. Fair and reasonable charges ensures the hospital receive a profit on their costs; the amount that Medicare would reimburse the hospital plus 25% – 50%.
10) OFFER A SETTLEMENT: Most people who are looking to negotiate would just ask the doctor or hospital to lower the bill. According to several studies, less than 15% of patients ask if their bill can be lowered. Of those who do ask to have their bill lowered, approximately 40% receive a discount. However before you ask for the discount, you should notify the hospital of the errors you may have found. Ask the hospital or doctor to remove the errors and send you a revised bill. Once you have received the itemized bill, now you are in a position to negotiate. With all of your information you can tell them that you are willing to pay what you consider to be a fair and reasonable charge; which is what Medicare would reimburse the hospital, plus 25% – 50%.
In many states both underinsured and uninsured patients whose income is less than $125,000 per year will receive the same discounts on their medical bills that insurance companies have negotiated directly with the hospitals. This means that people can receive a 40 to 60 percent price reduction on their medical bills. With a little research, patience and diligence everyone can get the same discounts.
Court cases say hospitals can collect only what is reasonable. Yes, all patients sign a form that states they will pay whatever is charged for treatment. But the courts have consistently ruled that hospital charges must be REASONABLE. That depends on the procedure, any complications, and in what area of the country you are hospitalized. Medicare plus 25-50% is a benchmark.
Don’t let your credit be destroyed! It’s important for you to take action and stick to your guns. Write to the hospital, credit agencies, collection agencies and anyone working on behalf of a hospital and let them know their bills are unreasonable. Writing a simple letter may be able to protect you and your credit.
February 8, 2012
FIGHT & WIN MEDICAL BILLS – By Rebecca Jarvis – ABC News
Check out the five tips below to help put money back in your pocket!
1. Request an itemized bill from your hospital. A recent study found that 80 percent of medical bills contain errors. With a system as error-prone as ours, you’ll want to make sure you are not paying for services you didn’t receive.
Ask what services are covered under your room and facility charges
Ask what treatments were provided
Identify the date and time of when you were admitted
Clarify medical terminology that is confusing
Specifically look for erroneous double charges, for mischarges, and for situations where a charge defies common sense (e.g., a $22 Q tip).
2. Comparison shop. Compare charges on your bill to other similar, nearby hospitals. Just like you would research buying a car or a home, you can research health care costs. Use tools like NerdWallet Health’s Best Hospitals tool or Medicare’s Hospital Compare to look up the cost of common procedures in your region. Even if it’s after the medical procedure’s been performed, you can still negotiate the prices of your bill. Use comparable information to challenge your hospital on their pricing.
3. Get the right person on the case. When it comes to your medical treatment, you go to your doctor. But when it comes to your medical bills, you typically need to go to the medical billing department. Get that itemized bill, go over it with a fine tooth comb, do some comparison shopping, and prepare yourself for extensive conversations with the hospital billing department. The more information you have when you begin this process, the better.
4. Ask to pay the Medicare rate. Medicare negotiates a 73 percent discount of the average hospital charge. Why should you pay more? Know what Medicare or an insurance company would pay for a hospitalization, and ask to pay this amount.
5. Negotiate how you’ll pay.
Ask for hospital payment assistance plans.
Offer to pay with cash – some hospitals will give a discount if you pay in cash
And, don’t give up! You can always call in a pro to help with the negotiating. Most medical bill negotiating services charge between 25 percent to 35 percent of what they save you on your bill.
The reputable services, according to healthcare consumer advocate, Michelle Katz, will never ask for your personal information or money upfront.
Jun 23, 2014
Check medical bills for errors. Overcharges are fairly common, and correcting them can save you thousands of dollars – Consumer Reports Money Advisor
While many of us have slashed our grocery, clothing, entertainment, and other spending over the past year, there may be one more expense we can cut: out-of-pocket medical costs.
Whether or not you have health insurance, you’ve probably seen your health-care expenses shoot up over the past several years. In a recent Consumer Reports survey, readers with insurance told us their costs for premiums alone went up 38 percent between 2006 and 2008.
While you may have no control over increases in premiums, co-payments, and deductibles, there’s no reason to pay more than you should because of billing errors. Yet Medical Billing Advocates of America, a national association that checks bills for consumers, says 8 out of 10 hospital bills its members scrutinize contain errors. Bills from doctors’ offices and labs tend to have fewer mistakes, but they do happen. What’s more, overcharges also bring you closer to the lifetime spending cap imposed by most insurance plans. Caps typically range from $500,000 to $1 million an individual.
Mistakes can result from typos or deliberate overcharges. The National Health Care Anti-Fraud Association, a Washington, D.C.-based group of health insurers and state and federal law-enforcement officials, estimates that at least 3 percent of all health-care spending—or $68 billion—is lost to fraud.
With a little time and perseverance, you may be able uncover overcharges. Here’s how to give your medical bills a nip/tuck.
Check before you’re charged
If you’ve ever tried to decode a health insurance statement, you may already know that insurers have a separate contract with each of your providers that determines how much they will pay. So there’s no single list of fees you can check. After you schedule a procedure, test, or lab work, phone the providers to ask what they will charge and which CPT codes they will be submitting to your insurer. CPT, short for Common Procedural Terminology, is a set of codes used by health-care providers to bill for procedures and services. Each code is five digits. Hospitals use another set of billing codes, called the Healthcare Common Procedural Coding System, or HCPCS. Usually five numbers long, sometimes with letters attached, they’re used for supplies, products, and medical equipment.
Next, call your plan’s toll-free number to ask for an estimate of the amount your plan will cover and what you’ll be responsible for paying. And for a possible bit of incentive, ask your insurance rep if the company pays a reward to patients who find errors on their bills; some do.
If you will be hospitalized, phone the facility’s billing department to ask what the room-and-board fee will be and what items that fee doesn’t cover, such as gowns or tissues, so you can bring your own. Ask your doctor to get permission for you to bring your regular prescriptions from home so you won’t have to pay steep hospital costs for them. Make sure everyone who will treat you participates in your insurance plan.
Keep a treatment list
Create a log of every test, treatment, and medication you receive. If you don’t feel well enough to keep your own record, ask a relative or friend to do it. Even a limited list will make it easier to decipher your billing statements.
Review bills as they arrive
The first statement you are likely to get is an explanation of benefits (EOB) from your insurance company or a summary notice from Medicare. Either statement will tell you the total amount being charged for your procedures, the amount your insurer is paying, and the amount you owe in deductibles and co-payments.
When bills begin to arrive from your doctors, compare the list of procedures with your notes. If you have a question about an item on a bill, phone that provider’s office directly for an explanation. If charges are grouped together in broad categories—for example, all lab tests are lumped under one charge—ask for an itemized bill.
If your treatment included a stay in the hospital, you’ll probably get a summary bill, which typically lists most charges under broad categories, including pharmacy, radiology, and surgical supplies. But hospital billing departments must send you a free, detailed bill at your request under the Patient’s Bill of Rights adopted by the American Hospital Association.
If you still can’t decipher some of the charges on a hospital bill, ask the medical-records department for a copy of your doctors’ orders and the nursing notes. They will include all the procedures, treatments, and drugs you were given. Also ask for a copy of the UBO4, which is the detailed bill the hospital sends to insurers. “If you still have questions, call your doctor or the nurse’s station at the hospital instead of the hospital’s patient advocate,” suggests Candace Butcher, CEO of Medical Billing Advocates of America. “They will be able to answer your questions quickly, which can save you additional phone calls.”
Look for these errors
If your name or insurer’s group number is wrong, the amount the plan covered is also likely to be. If you were in the hospital, see how many daily room-and-board charges are included. Many plans do not allow hospitals to charge you for your discharge day, although hospitals frequently do. And refer to your log for the time you were admitted. If you went to an emergency room but weren’t admitted until after midnight, you shouldn’t be charged for the previous day.
This is particularly important for medications, lab work, or hospital-room fees. Compare the charges with your doctors’ notes. Hospitals may bill a patent for a procedure even though a doctor canceled it. Also check the number of lab tests or procedures you had.
If you were charged for several lab tests in a day, for example, call your insurer to see if the charges should have been bundled under one lower fee. And look for the terms “kit,” “tray,” and “room fees.” Each of those terms covers charges for several items, such as gloves, IVs, or sheets. But Butcher says they often find separate charges for those items. “I have a hospital bill in front of me for a delivery-room epidural kit that also includes an IV charge that should have been included in the kit fee,” she says. “That alone is a $360 overcharge.”
Question any medical-sounding word that you don’t understand; you may find it should have been bundled with another charge. For example, an “oral administration fee” is really a charge for a nurse to hand you your medications, and it should be included in your room-and-board fee.
If you had surgery, your anesthesia record will state the time your surgery began and ended. Operating-room use is generally billed at rates that vary from $69 to $270 per minute. You might find, for example, that you were billed 240 minutes for a procedure that took only 180 minutes, a correction that will save you thousands of dollars. Also make sure you were not charged for items that should be included in the operating-room fee, such as gloves, linens, or light covers.
This practice inflates the patient’s diagnosis code to a more serious condition that requires more costly procedures, and can be the result of a simple clerical error or fraud. To spot it, compare the diagnosis on your doctors’ orders and nursing notes with the charges on your bill.
A charge can be needlessly inflated. For example, a doctor may order a generic drug for you that is readily available, but the hospital provides a more costly brand-name medication without your knowledge or consent, and bills you for it. Since you’re not an expert at determining whether or not a drug is a generic and you may not have been in a condition to make that determination, you are not responsible for the increased charge.
If you find a mistake
Call your provider, explain the error, and ask someone in the billing department to make the correction. For each call you make, keep a record of the time, the name of the person you spoke with, and what you were told. Those may be the only steps you have to take to get the matter resolved.
If that doesn’t work, call an account representative or the fraud department of your insurance company. Next, appeal to your state consumer-protection agency or your state attorney general’s office.
If you can’t get the problem resolved before the bill is due, you should pay the part of the bill not in dispute. Check your credit reports if things are not resolved within 60 days. After that time the unpaid amount may have been reported to the three major credit-reporting agencies and your credit score could be affected. You can find information about ordering your reports at www.annualcreditreport.com.
If you find the disputed bills on your reports as unpaid accounts, write to the credit bureaus to explain the ongoing dispute. The bureaus must review your complaint and correct your report.
Where to find bill-checking help
If you don’t have the time or are too sick to inspect your bills for errors, you can hire an expert to check them for you. Medical-billing advocates either charge an hourly fee, from about $50 to $175, or they work on a contingency basis, earning a commission of 15 percent to 35 percent of the amount they save you. If they take a percentage, you don’t pay a dime unless they lower your bill, which makes them highly motivated to do just that.
It’s a little tricky to find a medical-billing advocate because you may see them listed several ways online or in your local phone book, including as claims-assistance professionals, medical-claims professionals, or health-care claims advocates. You can find one through Medical Billing Advocates of America, which has 65 across the country. Keep in mind that most of their work will be done by phone, so they do not have to be nearby.
An unhealthy way to finance your care
Stay away from medical credit cards. They are advertised directly to consumers by some issuers or promoted by medical professionals as a way for you to cover pricey or elective procedures.
But the interest rates for the cards can reach exorbitant heights-as much as 27.99 percent. That’s the rate Chase HealthAdvance’s zero-interest plan charges if you miss a payment or don’t pay off the debt in the promotional period. By contrast, the average fixed-rate credit card was charging 10.7 percent in June, according to Bankrate.com.
The cards and financing are promoted to doctors, dentists, and even veterinarians as a way to get paid promptly. Hospitals have started offering their own co-branded credit cards. But using these cards has an additional drawback: You can lose the power to bargain for discounts or even obtain charity care.