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If you get a high medical bill in the mail, the amount might not necessarily be what you owe. Medical bill errors do happen, which is why it's important to request detailed bills and closely review everything you were charged for. Let's go over some common medical bill errors to watch out for and what to do if you believe there's a discrepancy with your balance.
1. Coding Errors
Health care providers use medical codes to show what care you received during your visit, and errors in these codes could increase the cost. For example, coding a 15-minute checkup as a 25-minute diagnostic visit could result in a higher charge. In some cases, coding errors can be honest mistakes. If the upcharges happen intentionally, however, it's considered "upcoding," which is a fraudulent way to make more money from patient visits.
Even though deciphering medical bills can feel like reading a foreign language, it's important to dig into the details to pinpoint fraud or mistakes. Researching codes online could help you make sense of it all. Doctors commonly use the Current Procedural Terminology (CPT) coding system, and you can find information on what CPT codes mean on the Centers for Medicare & Medicaid Services website.
2. Charges for Canceled or Refused Services
In some cases, tests, medicines, procedures or supplies that you refuse or that a doctor cancels may still show up on your bill by mistake. Carefully review each bill to make sure what's listed on the statement was actually performed and billed supplies were actually used.
3. Data Entry Mistakes
Simple clerical mistakes like errors in your insurance number or putting the wrong insurance company on your records can happen and result in your claim being denied. If you get a bill that seems too high, contact your insurance provider to see if the claim was processed properly.
4. Date and Length of Stay Errors
When reviewing your bills, double-check the dates of any hospital visits. If you stayed for a few hours, but your bill says you stayed all day or overnight by mistake, you could be charged significantly more.
5. Code Unbundling
Code unbundling is when a coder uses multiple codes for care instead of using one bundle code for the procedure as a whole. Itemizing bills in this way can result in a higher bill, and your health insurance provider may deny a claim that's higher than what's to be expected for the procedure. Unbundling may be harder to spot by someone who's not trained in medical coding, but checking your bill against code lists or enlisting the help of a medical bill advocate could help you identify items you can dispute.
6. Duplicate Charges
Double-check that you haven't been charged more than once for tests, medicines or supplies after staying at the hospital or getting a procedure done. Mistakes happen—but you shouldn't be on the hook for paying twice.
What Should You Do if You Find an Error?
You may be inclined to pay a medical bill right away just to make it go away, but remember it's important to make sure you're being billed correctly for care. Here are steps you can take to dispute bills you feel are inaccurate:
- Call your provider. Ask the billing office for an explanation on questionable items and request the removal of double charges or other errors you find.
- Call your insurer. If a claim has been submitted, contact your insurance provider for help resolving billing problems. If a claim ends up being denied, you can file an appeal with the insurance company to get another review. In some cases, you may be able to also request an external state or federal review of the claim.
- Enlist the help of a medical bill advocate. Medical billing is notoriously complicated. If you have trouble disputing medical bills on your own, you could try working with an advocacy group that specializes in helping people dispute errors and negotiate bills.
- Consider legal counsel. If your medical bills get sent to collections or you get sued for an unpaid balance while disputing your bills, an attorney may be able to offer advice on how to respond and negotiate a resolution.
Don't Be Afraid to Ask Questions—It's Your Right
When you get a medical bill in the mail, it's important to open it right away and follow up with questions as soon as possible because errors can take time to resolve. The good news is that the major credit bureaus give you a 180-day grace period before listing unpaid medical debt on your credit report after it goes to collections. This gives you time to find solutions to billing issues before the debt starts counting against your credit score.
What if your bills end up being accurate? There are several medical debt repayment options you could consider. For example, health care providers may be willing to negotiate a payment plan or settlement for less than what you owe. Just be sure to get the payment arrangement in writing.