How to Deal with Medical Bills that are Incorrect

by | Last updated Dec 7, 2023 | Published on Dec 23, 2013 | Medical Billing

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Regardless of whether you have health insurance or not, a huge medical bill for a hospitalization is something that needs to be scrutinized. Medical billing errors are quite common and may occur due to minor mistakes (such as if the billing staff inadvertently make an incorrect entry) or major mistakes (like use of the wrong codes, sending the bill to the wrong insurer as in the case reported in a Wall Street Journal article). It’s important to know about the type of errors that can occur, so that you don’t end up paying a huge amount of money that could land you in debt. Recent studies found that around 60% of the personal bankruptcy filings done in each year are related to medical bills. Here are some tips to detect mistakes in your hospital bills and how to deal with them:

  • Scrutinize Your Medical Bill – Once you get your bill, take a thorough look at it. Check for duplicate billing (charging twice for the same service, drugs or supplies), typos (wrong billing codes or dollar amounts), overcharging or inflated operating room fees (charging for more time than you used). You should also verify whether you are charged for additional days, doctor visits or tests that have not happened or were cancelled or medications that you never received. Be cautious on you are not billed for non-billable items which may be included in the room charge or charged in full for out-of-network services you did not agree on. So if you were hospitalized, ask for a complete itemized bill with the charges for each service or item clearly mentioned. You can then compare it with the services you were provided.
  • Track the Mistakes – If you find something wrong, review your insurance company’s explanation of benefits (EOB) to find out the reason for this anomaly. The EOB will include the name of the provider of service, the date of service, the service delivered, the provider’s charge, the amount payable after deductibles and co-payments and an explanation on denials, rejections and non-reimbursements. If you have a HMO (Health Maintenance Organization) plan, ensure that you are charged at in-network billing rate if there is a yearly cap on any service.
  • Take Necessary Action – When you find the charges are unjust, contact the billing department or officer manager at your physician’s office for assistance. In case of dealing with problematic hospital charges, contact the chief financial officer and seek help from your insurer. If your health care plan is obtained through work, human resource departments can intervene to resolve the disputes with your health care provider. The relevant insurance agents can help you if you bought insurance from private market.

On their part, hospitals and physician practices have to be wary of inadvertent overbilling. Violations of the FCA (Federal False Claims Act) can result in a mandatory penalty of $5,500 and $11,000 per violation. All damages are three times the amount of the claim and legal fees. In fact, healthcare providers can avoid such issues and adhere to proper coding and billing with professional medical billing services which ensure that every claim is double-checked before it sent out.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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