The Life Transition Blog

Fight Medical Bill Errors

Medical bill errors, including those on hospital bills, can quickly become a nightmare for you, the patient, if you don't keep on top of them. The longer an error goes uncorrected, the less likely it is that you will be able to successfully fix it. Hospitals, physicians, and other providers are likely to send your account to collections if it is not paid within a few months. While each entity follows its own guidelines with regard to how quickly it considers an account to be delinquent, most expect your bill to be paid in full unless other arrangements have been agreed to within 90 days of the date of service or 45 days of when your insurance plan has processed the claim. Failing to pay your medical bills is very likely to affect your credit, and unpaid hospital bills are a major reason why people file personal bankruptcy.

It is particularly critical that you stay on top of billing errors if you have health insurance. This is because there is something known as "timely filing" in the insurance business. If you have medical insurance, the plan documents must indicate how long you or your provider has to submit claims. Once that time has passed, it is permissible for the insurance company to deny your claim because it wasn't submitted within the required time period. At this point, the entire bill becomes your responsibility. Similarly, if you don't agree with how your claim has been processed, you have a finite period of time to appeal the decision and escalate it through the insurance plan's dispute resolution process. If you miss the appeal deadlines, you're usually out of luck.

There are many different kinds of medical bill errors so you must have an eagle eye when you review your bills. Perhaps the simplest error for a lay person to find is a charge for a service that was never provided. For example, if you were billed for a hearing test that you never took, make sure to dispute it. The fact that the clinician ordered the test and marked it on the "superbill" at the time of the visit is irrelevant if the audiologist never performed the test and recorded the results. Your medical record is the governing document when it comes to these disputes. If it's not in the records it shouldn't be billed. If you find yourself in this situation, request a complete copy of your medical records and a detailed itemized statement. Then, take the time to compare what's in the records with the statement and dispute any discrepancy.

Another common situation is duplicate charges where the provider has billed you for the same service more than once on the same day. While this makes sense sometimes, such as when you have an x-ray of both your right foot and your left foot, the provider needs to use a special code called a modifier to explain this to the insurance company. In addition, keep watch for charges for things that the hospital or doctor isn't supposed to bill for separately. For example, if you have had surgery, the follow up care should be included in the "global fee" for that service. For major procedures, that means that you shouldn't be charged for a follow up visit within 90 days of the date of the surgery. You can, however, be charged for additional services other than the office visit itself, such as an x-ray or cast. Similarly, if you are hospitalized, the hospital shouldn't charge separately for sheets for your bed or your hospital gown, both of which are included in the "room and board" charge.

If all of this seems a bit overwhelming, you might wish to retain a medical bill advocate. Billing advocates are trained to spot errors, negotiate with providers, and where possible help you to reduce your bills. You can learn more about medical billing advocacy at http://www.attackmedicalbills.com/ or http://www.billadvocates.com/.
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