Disputing a Medical Bill
After a medical procedure, you may receive a bill that feels unreasonable. It’s not a great feeling when you have been unwell and now have a massive amount of debt. Here are a few tips for disputing your medical bill.
Double check the medical billing code
When determining charges, hospitals use billing codes. This means that they enter a number for a procedure, and that procedure corresponds to a charge. But if billings codes are entered manually, there’s always potential for human error. This can result in an incorrect charge.
So be sure to check if the billing code is correct for the procedures that were performed.
Take Notes on Interactions with Medical Professionals
Here are a few things that you should keep track of so that you understand what is going on:
- Date and time
- People in the conversation. Try to get their names and an ID number if possible
- Facts of the conversation and additional details.
- Projected Timeline for actions that will be taken. If a professional mentions something that needs to be completed, ask follow up questions to establish a timeline. For instance, ask, “On what day should this be completed?” or “When should I see results on this?”
- If you’re having these conversations over the phone, document the number you called and the length of the call. But if you’re communicating through mail, make multiple copies of what you send, and send everything through certified mail.
Review your bill and the explanation of benefits
Take a long look at your medical bill and your insurance company’s explanation of benefits.
Defining an explanation of benefits
Your explanation of benefits should tell you how your insurance applies to your medical bill. It should include the following:
- The charge from the doctor or hospital
- Discounts applied by the insurance company
- Insurance company contribution towards the bill.
- Amount that you are expected to pay.
The Explanation of Benefits should match your medical bill! If your medical bill does not apply discounts or the insurance contribution, there is an error. You would be responsible for paying unnecessarily unless you correct this error.
Get a detailed line-item bill
Once you’ve determined there is a discrepancy between the explanation of benefits and your medical bill, you’ll need a detailed line-item bill. This bill should list out these things:
- Date and time
- Medical billing CPT code
- Description of the charge
- Total price
- Insurance adjustment
- Patient amount due
You’ll have to spend time looking up medical billing codes. Although this is tedious, you can identify errors in data entry or documentation.
Call the Medical Provider Billing Department
If you’ve found an error, you may be able to reach a resolution by contacting the customer service line.
If there is an error, inform the department of the mistake and ask how to correct it. You’ll probably be informed that the service agent will:
- Request research from their team
- Put your bill on hold
- Reach back out to you ___ weeks
Always be sure to document this conversation. Take detailed notes, and clarify what they expect from you while you wait to hear back.
You may be expected to pay the undisputed charges on your bill.
If you’re disputing the total amount of your charge, you may be able to get assistance from the customer service agent. Sometimes they offer you a discount for paying immediately. If you’re still encountering issues, you can speak with a supervisor. You may even receive a bigger discount.
File an appeal with your insurance company or medical provider’s patient advocate
If those steps were unsuccessful, you can also file with your insurance company or medical provider’s patient advocate. These additional appeals put pressure on the hospital to resolve the issue quickly.
Patient advocates associated with your medical provider may also be helpful in finding a solution. They can sometimes get you discounts too, and they can connect you with resources that help if you can’t afford your medical bills.
Involve your State Insurance Commissioner
Some states have law departments that help consumers navigate health insurance. You’ll need clear documentation of errors and you need to fill out additional paperwork. You can dispute medical billing errors or dispute health insurance claims as well.
File a small claim
As you consider pursuing legal actions, you may want to send a demand letter. It is also known as a notice of intent to sue, and it should be sent before filing in court. Many cases are resolved through strongly worded demand letters. It is advisable to send the letter on professional letterhead. Dispute can generate all of that for you - simply click 'Send' at our website and we will print and mail your letter for you.
You can easily file a small claim with Dispute. Our tools make it easy to generate paperwork, and once you’ve filled out some basic information, you can file online with a click. We’ll update you with progress on your filing, and you can always check your Dispute dashboard for actions to take or status updates.