For Cheaper Health Care Always Check Your Bill

You’re a conscientious consumer. You balance your checking account and review your credit card statements every month. But how much attention do you pay to your doctor bills? The Medical Billing Advocates of America claim that 80% of all medical bills contain errors, and (no surprise here) they generally aren’t in your favor. Inaccurate medical bills can ruin your credit, too. A December 2010 report from the Federal Reserve claims that medical bills account for more than half of all U.S. debts in collection. With
health care and health insurance costs rising, controlling health care costs and protecting your credit rating could be as simple as reviewing your medical bills for expensive errors.

Billing errors come in all sizes and flavors, ranging from honest cleric mistakes to outright fraud. One common cause of error is the simple typo. Numbers get transposed. For example instead of keying in $47.50, the billing clerk enters $74.50. Or fat fingers enter $290.00 instead of $29.00. Double billing (you’re charged twice for the same service) is another common mistake. If something looks overpriced, flag it.

Miscoding is a fairly common error, too, and it’s a mistake that’s getting easier than ever to make.  Health care providers currently use a system of some 18,000 standardized codes to describe medical services when billing your insurance company. Now the federal government is expanding the codes to around 140,000. As reported recently in the Wall Street Journal (8/13/11), your health care provider and health insurance company can now specify whether that injury you sustained resulted from being bitten by a turtle or merely struck by a turtle. That’s an amusing example, but not an extreme. There are two codes for
describing sex change operations, 195 codes for suturing an artery, and a whopping 2,595 different codes to describe a badly healed fracture. The code expansion is being done, according to the government, in the interest of precision, data accuracy and quality of care, but the more codes there are, the greater the
chance for billing error.

The complex billing code and an antiquated billing system also enable intentional fraud and abuse. Some common examples include billing for services that weren’t provided; up-coding (billing for a higher level of
service than was actually provided); providing unnecessary services; renaming a non-billable procedure to a billable one; and unbundling a single procedure, then billing separately for each step. Some experts say these types of fraudulent practices account for as much as 10% of all health care costs. Worse, they can make their way into your health care records, leading to potentially dangerous medical treatment and inaccurate entries in your Medical Information Bureau records.

How to Fight Medical Billing Errors

  • Never pay a bill that only includes a summary of services. You can’t spot errors on a summary. Federal law says you’re entitled to an itemized bill on request, so request it already!
  • Review the bill carefully and make sure you weren’t charged for anything you didn’t actually receive. While you’re at it, check that the dates of services are correct.
  • Keep records of all medical bills. This will help you spot duplicate charges.
  • If you spot a discrepancy or see something you just plain don’t understand, question it. Be polite but firm. Don’t let anybody blow you off. If you’re getting nowhere, ask to speak to a supervisor. Get the full name and title of anyone you talk to. Take notes including the time and date of the conversation.
  • Challenge any denial of coverage from your health insurance provider. Insurance companies make mistakes, too.
  • If you have disputed charge and can’t get a simple resolution over the phone, request an internal audit. Many hospitals and larger clinics have their own auditors, and you have every right to ask that they review a disputed bill.
  • For really big errors or if you suspect fraud is involved, you can always hire a professional billing advocate. They typically charge a percentage of the money they save you or an hourly fee based on results achieved. Get the terms in writing and never pay upfront.




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