Jane Dotson
Medical bills are an inevitable part of life, but they can be complicated and hard to understand. Errors and extra charges can show up on your bill, and sometimes you may be billed for services that should be covered by your insurance. If you think there's been a mistake, you can take steps to dispute the bill and reduce your payment. You can start by reviewing your bill and explanation of benefits, and then requesting a detailed, itemized copy of your bill. You can then compare this to your insurance plan to see what charges you're responsible for and what your insurance company is responsible for. If you think there's an error, you can contact your insurance company and file an appeal. If this doesn't work, you can try a medical advocacy agency or negotiate directly with your medical provider for a discount.
| Characteristics | Values |
|---|---|
| When to contest a medical bill | If there is a billing error, an unexpected out-of-network charge, or a surprise medical bill |
| What to do when contesting a medical bill | Ask for an itemized copy, review the bill and Explanation of Benefits report, compare it to your insurance plan, check for double charges, coding mistakes, and incorrect calculations, and contact the medical provider |
| How to dispute a medical bill | File a complaint with your health insurer, contact your state insurance commissioner, or reach out to the Consumer Financial Protection Bureau |
| What to do if you can't pay a medical bill | Apply for financial assistance programs, negotiate with the medical provider, or reach out to a medical advocacy agency |
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What You'll Learn
Review your bill for errors and extra charges
Reviewing your bill for errors and extra charges is an important step in disputing a medical bill. Medical bills are often complicated and hard to understand, and errors and extra charges can sometimes occur. Therefore, it is crucial to carefully examine your bill and identify any discrepancies or unexpected costs. Here are some steps to guide you through this process:
Firstly, request an itemized copy of your bill. This means asking for a detailed breakdown of each charge, so you can understand exactly what you are being billed for. This step is essential as it provides transparency and allows you to identify any potential issues.
Once you have the itemized bill, go through it line by line. Look out for any double charges, coding mistakes, or incorrect calculations. For example, check if the \"plan discount\" has been applied correctly, as this is a common error that can result in a higher bill. Additionally, compare the items on the bill to your health insurance plan. This will help you identify which charges are your responsibility and which should be covered by your insurance company.
If you receive Medicaid, it is important to note that charges should be billed directly to Medicaid, not to you. Medical providers are not allowed to charge more than Medicaid allows. If your doctor doesn't accept Medicaid, they are required to inform you before the procedure, and you must provide written consent.
In addition to reviewing the itemized bill, obtain and carefully review the Explanation of Benefits (EOB) report from your insurance company. This report explains what charges they have covered for that specific date and healthcare visit. Compare this report with your itemized bill to ensure they match. Any discrepancies between the two could indicate a billing error.
If you identify any errors or unexpected charges, contact your medical provider and insurance company. Explain the issues you have found and request that they review and rectify any mistakes. Your insurance company may be incentivized to resolve the issue, especially if they have also been overcharged.
Remember, it is within your rights to dispute a medical bill if you identify errors or unexpected charges. By carefully reviewing your bill and following the steps outlined above, you can effectively identify and address any discrepancies, protecting yourself from unfair financial burden.
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Compare your bill to your Explanation of Benefits
An Explanation of Benefits (EOB) is a document sent by your insurance provider that explains how your insurance processed the claim for the services you received. It is not a bill, but it is a useful tool that shows you how your bill is divided between the medical service provider(s), your insurance, and you. It also helps you understand how much your health plan covers and what you'll pay when you get a bill from your provider.
When you receive your EOB, compare the amount you owe on it to the amount on the bill from your doctor or healthcare provider. If they match, that's the amount you'll need to pay to your doctor's office. However, if there is a difference between the two, call your doctor or clinic to see if your account has been updated with a payment from your insurance company or elsewhere since the bill was sent.
Your EOB will also list your health plan's phone number, so you can call them if you have questions about finding a provider or what services they cover. It gives you details about your care, such as a service description, which explains what service you had, and the cost of your care. It will also list the amount your provider will be paid and the amount your health plan will pay to your provider.
If your bill and EOB don't match, there could be a few reasons. For example, your bill might include charges for more than one date of service, or a payment may have been made between when the EOB and bill were sent. If you receive treatment in a hospital, you will likely get at least two separate EOBs: one for hospital charges and another for the doctor's time.
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Contact your medical provider
Contacting your medical provider is an important step in disputing a medical bill. Here are some detailed steps and considerations to keep in focused on this topic:
Understanding Your Bill and Identifying Discrepancies
Before reaching out to your medical provider, it's crucial to thoroughly review and understand your bill. Request an itemized or detailed line-item bill from the medical provider's billing department. This breakdown should list every charge, making it easier to identify any discrepancies. Look for double charges, coding mistakes, and incorrect calculations. Compare the items on the bill to your health insurance plan to differentiate between charges you're responsible for and those covered by your insurance. Additionally, cross-reference the bill with any Explanation of Benefits (EoB) provided by your insurance company, which outlines what they've covered for each healthcare visit.
Communicating with Your Medical Provider
Once you've identified potential errors or discrepancies, contact your medical provider to discuss the bill. Explain the issues you've found and request that they review and rectify any mistakes. If they disagree with your insurer's denial of coverage, ask them to provide a letter outlining their reasoning. In some cases, your doctor may suggest that your insurance company should cover certain expenses, which can be helpful in your discussions with the insurer.
Resolving Billing Errors
If billing errors are discovered, your medical provider should be willing to correct them. They may reduce your bill or offer other solutions. Remember that your provider cannot move your bill into collections or threaten to do so while the dispute process is ongoing. If the dispute is resolved in your favour, any administrative fees you paid during the process will be deducted from the amount you owe.
Understanding Your Rights and Protections
Familiarize yourself with relevant laws and protections, such as the No Surprises Act (NSA), which protects insured individuals from certain billing practices, like requiring them to pay out-of-network charges for emergency services. If you received a surprise bill for medical services after July 1, 2017, and paid more than your in-network cost share, you can file a complaint with your health insurer. Additionally, state agencies, such as the state insurance department or insurance commissioner, may offer helpful information and complaint processes.
Negotiating and Seeking Financial Assistance
If you're facing financial difficulties in paying the bill, even after disputing it, consider negotiating with your medical provider. You can ask for a discount and provide proof of income, large expenses, disability, or other supporting documents. Some providers may offer immediate discounts of up to 20%. Additionally, inquire about financial assistance programs or "charity care" that can provide free or discounted healthcare to those struggling financially.
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File an appeal with your insurance company
If your insurance company refuses to pay a claim or ends your coverage, you have the right to appeal the company's decision and have it reviewed by a third party. The first step is to carefully review your plan and talk to your insurance company. If you're sure they should be covering the bill or reimbursing you, file an appeal. This usually has to be done within 30 to 60 days, or 180 days in some cases. Make sure to include your medical records, letters from your doctor that say why they disagree with the insurer's decision to deny coverage, and any other important information.
There are two ways to appeal a health plan decision: Internal appeal and External review. If your claim is denied or your health insurance coverage is canceled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process. At the end of the internal appeals process, your insurance company must provide you with a written decision. If they still deny you the service or payment for a service, you can ask for an external review.
If your appeal is denied, try a medical advocacy agency that works with clients for free. They can work with your insurance company or your doctor to find a solution on your behalf. If these steps don't solve the problem and you end up still having to pay, you can negotiate with the medical provider. Ask for a discount and be prepared to send proof of income, proof of large expenses, or other documents like tax records or bank statements.
If you go to an in-network facility and want to see an out-of-network provider, you must give your permission in writing by signing a form provided by the out-of-network provider at least 24 hours before receiving care. If you receive a surprise bill for medical services provided after a certain date and have already paid more than your in-network cost share, file a complaint with your health insurer with a copy of the bill. Your health insurer will review your complaint and should tell the provider to stop billing you. If you do not agree with your health insurer's response, you can file another complaint with the relevant department.
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Seek free help from a medical advocacy agency
If you have received a medical bill that you think is unfair or incorrect, there are several steps you can take to contest it. Firstly, carefully review your insurance plan and talk to your insurance company. If you are certain that they should be covering the bill or reimbursing you, file an appeal. This must usually be done within 30 to 60 days, and you should include medical records, letters from your doctor, and any other relevant information. You should also contact your doctor or hospital about the dispute, as they may be able to reduce your bill.
If your appeal is denied, you can seek free help from a medical advocacy agency. These agencies can work with your insurance company or doctor to find a solution on your behalf. You can find a patient advocate by searching online for advocacy groups that help with medical bills in your state or for a specific disease or condition you have. Many hospitals also have patient advocates on staff, so it is worth calling the hospital and asking. The Patient Advocate Foundation, for example, has over 45 case managers who provide one-on-one counselling. There may also be community resources or disease-specific organizations that can assist, such as the free Heart Valve CareLine for people with heart valve conditions.
If you have received a surprise bill, you may be protected under the No Surprises Act or other consumer protection laws. For example, in California, consumers are only required to pay their in-network cost-sharing amount, and medical providers are prohibited from sending consumers out-of-network bills when they have followed their insurer's requirements and received non-emergency services at an in-network facility. If you believe your rights have been violated, you can file a complaint with your health insurer or with the appropriate government department.
It is important to note that if you used health insurance, you may not qualify to dispute a bill. Additionally, there may be a non-refundable administrative fee required to file a dispute, typically $25, which will be deducted from the amount you owe if the dispute is decided in your favour.
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Frequently asked questions
If you receive a surprise medical bill, you should first figure out whether that bill is illegal under the new federal law. If you have health insurance, the No Surprises Act (NSA) protects you from “surprise billing”. If you are uninsured, the NSA also provides some protections from surprise medical bills.
If you discover an error on your medical bill, you should contact your insurance company as they will not want to pay more than they have to. If they agree that you have been overcharged, they may be incentivized to resolve the issue with your medical provider.
If you are unable to pay your medical bill, you should first check that you actually owe the bill. It is possible that you have already paid it or that the provider has confused you with someone else. If you need financial assistance, you may qualify for a "charity care" program, which provides free or discounted health care.
When contesting a medical bill, the first step is to ask for an itemized copy of the bill. Once you have this, you can go through the bill line by line, looking for double charges, coding mistakes, and incorrect calculations.
To dispute a medical bill, you will need to pay a $25 non-refundable administrative fee. An independent third party will then review your bill and determine an appropriate payment. If the dispute is decided in your favor, the $25 fee will be deducted from the amount you owe.
