Medical Bill Mistakes: Are You Paying More Then You Should?

Receiving medical bills is about as fun as getting junk mail—and sometimes I feel like putting them in the same place: the garbage! With a background in medical billing, I always review my statements carefully and double-check with my insurance. Yet, I often wonder how many people take the time to examine what they’re actually paying. The answer: not enough.

If you have insurance and see a doctor, the first step is checking your provider list for in-network doctors. These contracts usually guarantee a discounted fee. Your bill should look something like this:

Chest X-Ray ------------------ $55.00
Insurance Payment ------------ $20.00
Insurance Adjustment -------- $15.00
Patient Responsibility ------- $20.00

The adjustment is key. If there’s no adjustment and you were in-network, the provider may be balance billing, which is illegal in most states. Often it’s just a clerical error. Call the provider—they’ll usually correct it quickly.

While working as a medical biller, I often would see bills go out to patients for the full amount as non-covered (some services are not covered by insurance and hopefully that would be something you would check on before stepping into the doctor's office). What had actually happened was that an old, expired insurance was billed instead of one that was in effect. When you change insurances, it is your responsibility to inform the provider but if they don't change it in their system, that is their problem. And unfortunately, I saw that a lot. The office would take the insurance information and never add in the new information or once added the computer system would automatically revert to the old insurance after every visit. The expired insurance will deny the claim as non-covered and if not carefully reviewed by an account representative, that denial will be passed on to you.

I avoid this by making sure my medical provider has my current information before I leave the office. Then, in two or three weeks I double check my insurance website to see if the doctor has put in his claim. If not I check back in another week. By then, if there still is no claim I give the doctor's office a call. Too much work? Review your bill and then call the doctor's office and raise hell, whatever works.

Doctors and medical facilities are responsible for submitting claims on time. Occasionally, a claim is denied for “timely filing,” and the bill is passed to the patient. Never pay these blindly—contact your insurance first.

This happens more often with hospital stays then with individual doctor's visits. But that does not mean it does not happen. Always review the services on your bill, every statement should come to you with an itemization of what was done. If it doesn't check out the claim on your insurance website. Did you get billed for an MRI when you had CAT scan or maybe just a chest x-ray? Take a moment to look at the services, one way or the other a mistake like that will cost you.

If you receive a bill you thought was paid, double-check your records. Payments may have been misapplied to someone else’s account. Even if the provider issues a refund, it may take months, so patience—and vigilance—is key. Check out this site for more help https://www.cms.gov/medical-bill-rights/help/guides/bill-errors.

Mistakes in medical billing happen frequently. The way to avoid paying more than necessary is to stay informed and attentive. Know your insurance, understand what’s covered, and check state laws to know your rights. A little diligence can save a lot of money—and stress.