Imagine you are hospitalized for a minor accident and the hospital charges you a huge amount, much higher than you expected your treatment to cost. This situation could be the result of medical billing errors or due to deliberate overbilling by the provider. If you think that you have been overbilled or billed wrongly for medical care you received, you should know how to handle the situation. Here’s what experts say:
Be Aware of Your Rights – You have the legal right to ask for an itemized bill. Certain hospitals may give inexplicable reasons for not providing an itemized bill that shows each and every detail of how your stay was charged. The truth is that most states have laws that say patients are entitled to an itemized bill. A few states have laws limiting how much hospitals can charge patients who pay for the services on their own. California passed a law in 2006 which prevents hospitals from charging uninsured patients more than what Medicare or other public insurance programs would pay for the same service. In California, if a patient contacts the hospital and proves evidence of their financial situation, state law requires the hospital to provide a discount based on Medicare rates. So, contact the billing department of your medical facility, request an itemized bill and let them know that you are aware of your legal rights to have one.
- Ask Explanations in Writing and Take the Issue to Top Level – Whatever communications you have with your health care provider should be in writing. Write to the billing department and insist that your account be placed on hold till the issue get resolved to avoid sending the bill for collection. If you do not get the response that you need, stop calling the customer service and address a certified letter to chief executive or chief financial officer of the medical facility that you have tried to resolve billing dispute but couldn’t find a better solution. Pat Palmer, the founder of Medical Billing Advocates of America (national advocacy firm of professionals dedicated to protecting and servicing consumers and businesses) says CFOs and CEOs would take this matter very seriously.
- Get Relevant Information from Your Insurer – Contact your insurer and make sure that the medical facility from which you have taken care is included in the network of providers specified in the plan. Also, ensure that the facility is charging you at the price negotiated by the insurer. Susan Pisano, spokeswoman for the trade group America’s Health Insurance Plans, says it is a good idea to stay in network as the insurers would always have the responsibility to seek what happens between the patient and contracted health care provider. Most insurers pass insurance claims without processing them at the reduced rate. Ask your insurer to process your claim again if the reduction wasn’t applied.
- Seek Expert Help and File Complaints If Necessary – If you have a large bill to settle and are having a hard time fighting it out by yourself, don’t hesitate to seek help from experts. You can consult medical billing advocates who can help you fight charges or lower your bill. If the health care provider does not respond to your issues in proper the manner and your insurer hasn’t helped, you can file a complaint with your state’s department of insurance. In case the provider is not included in the contracted providers’ network specified in your plan, the state’s attorney general’s office can help you.
You should also know that your billing problem could have been the result of inadvertent coding or documentation errors. Medical facilities that partner with a professional medical billing and coding company can avoid such catastrophic errors as they would have a professional team of certified coders handling the task.