Charged More Than You Owe? How to Dispute Medical Bills
Whether you’re insured or uninsured, health care costs can be expensive. Medical debt can add up over time, particularly given fees and interest that come with unpaid bills and late payments.
That’s why it’s all the more frustrating to discover that you’ve been overcharged for services, charged for services you thought would be covered by your plan, or, worse yet, charged for medical treatments or services that you didn’t even receive.
If you have a bill from an emergency room visit, from your insurance, or from a medical care provider that you think is wrong, don’t panic. There are steps you can take to resolve it. In this article, we’ll outline what you can do to dispute a hospital bill or any medical bill when you’re overcharged or charged more than you expected.
How Common Are Medical Billing Errors?
Medical billing errors by both health care providers, health insurance companies, and doctor’s billing offices are unfortunately more common than not. As of 2021, it’s believed that 80% of all medical bills received by Americans contain at least a minor error, which makes billing disputes a matter of everyday business in the world of health care.
When you receive a medical bill that contains hundreds, thousands, or even tens of thousands of dollars worth of errors, and are being bombarded with phone calls from collections offices, the stress can feel overwhelming. Here are some steps to take if you feel you’ve been inappropriately overcharged for a medical procedure or service.
What Causes Medical Billing Errors?
There are a few major reasons that medical billing errors and surprise medical bills occur. Some incorrect medical bills are simply a result of computer discrepancies, while others can be traced back to human error:
- Incorrect coding: The vast majority of medical facilities utilize a complex system of diagnostic codes in their billing process. If such billing codes are off by as much as a single digit, patients can be accidentally charged for procedures.
- Typos: Typos, incomplete information, or incorrect information entered into medical billing systems can sometimes result in providers overcharging patients.
- Duplicate billing: Hospital and medical providers are not immune from billing patients twice for one treatment or procedure.
- Misinterpreted notations: Misread notations from doctors, nurses, or billing department professionals can also result in invoicing errors.
- Fraud: Some erroneous or inflated medical costs are due to fraud. There are documented cases of health care providers intentionally utilizing incorrect diagnostic codes in a process called “upcoding” to generate more revenue.
Many patients never discover the exact cause of why they’ve been overcharged on a medical bill.
4 Key Steps to Take to Dispute Medical Bills
The most important step is making sure you’re not held accountable for erroneous charges. Here is a progression of steps to take if you feel you’ve been inappropriately charged for a medical procedure or service.
1. Carefully Review Your Bill
By law, medical care providers are required to be as transparent as possible about the costs of services and treatment, but not every provider follows these rules. The vast majority of medical bills patients receive in the mail are actually condensed versions.
Condensed medical bills not only leave out many details about charges, but also tend to group fees and related costs into categories, which doesn’t always provide you with a thorough picture of services provided.
If you think you need to dispute a medical bill from a doctor’s office, insurance company, or health care provider, contact them and request an itemized bill which may give a more detailed overview of the coverage you received and better illustrate errors and/or discrepancies.
2. Review Your Benefits
It’s smart to review the Explanation of Benefits (EOB) to make sure your health insurance plan does, in fact, cover the services you received. While this is a step that’s obviously best taken before you receive treatment, it’s not uncommon for patients who think they’re being overcharged on a bill to find out retroactively.
Another sound reason to review your EOB is to determine that your treatment or service was covered by in-network providers. A common reason for medical overbilling is the fact that people mistakenly utilize medical care providers their insurance provider doesn’t cover, and only find out after the fact.
3. File an Appeal With Your Insurance
Patients who received an erroneous medical bill because their health insurer refuses to pay for a claim for services or treatment have a right to appeal to a third party under federal law. According to Healthcare.gov, there are two ways to appeal these decisions.
In an internal appeal, patients can request that their insurance company conduct a full and fair review of their decision.
In an external review process, patients have the right to request that a third independent party make an impartial review of the insurance company‘s findings.
4. Contact Patient a Advocacy Firm
If you have a disputed medical bill, a medical billing advocacy company can analyze disputed medical bills for you to try and find instances of over-charging, duplicate charging, and fraud. Unfortunately, this is a fee-based service. Medical billing advocacy firms can charge hourly fees that range from $75 to $350 per hour while they attempt to remove your bill from collection accounts.
Patient advocacy firms can also help to negotiate it down to a more reasonable amount if it’s discovered not to be erroneous. However, it’s not uncommon for them to charge you a percentage of the amount your bill has been reduced by.
Will Disputed Medical Bills Affect My Credit Score or Credit Report?
Disputed medical bills can affect your credit score and credit report, but the process is not immediate. If you’re disputing a charge and not paying it while you take time to resolve the matter, you have limited time to get it resolved before unpaid medical bills affect your credit score.
It can take between 60 and 180 days for medical care providers to submit unpaid bills to debt collection. The three major credit bureaus (Experian, TransUnion, and Equifax) created a 180-day grace period before debt from medical services and doctors’ bills appears on people’s credit reports. This was started to bring standardization to medical debt reports and to protect consumers’ credit scores from being affected by medical debt too quickly.
Medical collections can stay on an individual’s credit report for seven years, and can have a devastating effect on your personal finances. Payment history is one of the biggest influences on credit scores issued by the three major bureaus, accounting for approximately 35% of scores. This is why having unpaid medical debt can have such a large effect on your credit score if it goes unresolved.
Many creditors and collection agencies allow people with medical debts to establish monthly payment plans, sometimes at reduced rates, which you can utilize to get your medical debt resolved sooner.
Compare.com is a terrific resource when it comes to learning more strategies to negotiate and hopefully reduce your medical bills. It’s also important to remember that many health care providers and insurance companies offer financial assistance programs that may help you pay off medical debt at lower rates. Contact your provider or insurance company‘s patient advocate department to learn more about these programs.
To avoid surprise bills, make sure you know how much your medical procedure should cost so you can advocate for yourself. Use Compare’s price comparison tool below to find out exactly what your procedure should cost in your area.