Medical Billing Errors and What You Can Do

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Medical billing mistakes can and certainly do occur. More often than not these errors are not done with malicious intent, but regardless it is your money at stake and sometimes the stakes can be very high.

You don’t have to a medical billing expert or auditor to look for red flags when it comes to your medical bills and here are some things to understand and look for.

  • Understand your health insurance plan benefits. Read your insurance coverage information or call the number on the back of your card and have a representative review specific information with you.
  • View the insurance Explanation of Benefits (EOB) and the hospital/clinic/physician bill.

Now these are two different documents sent at two different times. The EOB sent by your insurance company is not the bill so don’t pay that one. The EOB goes over what was covered, not covered, what savings occurred, and what you may owe. Save the EOB and compare it to your bill you get from the hospital/clinic/physician. I say hospital/clinic/physician because you might get a bill from each one for the different services they provide at the same time. Think of it this way, when you go to the hospital, the hospital charges you for sitting in their office, using their supplies, nursing services, etc. Also while you are there in the hospital the doctor or advanced practitioner has to get paid, separately, for their professional work to take care of you. That is why sometimes you get a bill from the hospital or clinic and the physician. Some facilities practice “patient friendly billing” and combine them to make it less difficult to understand.

Now that you know the difference between and EOB and your bill look out for these things in your bill:

  • Dates of service– are these correct for the dates you were seen?
  • Diagnosis – does your bill contain your diagnosis (what you were seen for) and does it make sense, it is correct?
  • Procedures – Is there a list of procedure codes on the bill (if not, ask for them) and do the descriptions make sense? For example, if you are a male patient and the descriptions says something along the lines of “Cesarean delivery” that is probably not right.
  • Quantity of codes – Many times an inaccurate number of quantities could be mistaken keyed on your bill. For example, only “1” procedure could have been accidently typed in as “11”.

Once you find the errors call the hospital/clinic/physician to review them. You might not want to come at it from a hostile angle; it won’t get you very far. However, this is your money and you have the right to ask for the bill to be reviewed in a reasonable time (1 week or so). Also call the insurance company to review these potential errors.

Tips: Write down whom you talk to, when you talk to them and what was discussed. Be sure to ask the hospital/clinic/physician to hold billing so they don’t send you to collections while you are waiting for them to review the bill. Also, if you don’t feel like you are connecting well with the person you are talking with on the phone or getting anywhere ask politely to speak with a supervisor. If all these seems daunting, and trust me it is and can be, you can reach out to a medical billing advocate. KaleidoCare specializes in medical billing advocacy and can help, www.kaleidocare.com

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