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Checking Your Medical Bills for Errors

August 06, 2019 · 5 minute read

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Checking Your Medical Bills for Errors

When you run into a health issue, there’s already a lot on your mind. Whether you’re dealing with a broken arm, delivering a baby, or reeling from a serious diagnosis, you’re likely to be more focused on your health than the cost of care. But medical bills can sometimes be just as stressful as the illness or injury itself.

Medical bills represent a major financial challenge for many families. Collectively, Americans reported borrowing around $88 billion to pay for health care in 2018. And medical issues were a factor in more than two-thirds of bankruptcies, driving about 530,000 households each year to file, according to a 2019 study led by researchers at Harvard Medical School and other universities.

You can’t always prevent or foresee medical bills, even if you have insurance. But you may be able to take steps to get your medical debt under control.

One step you may want to consider is to complete a medical bill review to make sure you’re not being overcharged.

A 2018 national survey from Consumer Reports found that two out of three insured adults who had medical bills in the past two years experienced an issue such as unexpected charges or confusing statements. By understanding what mistakes to look for in your medical bills, you may be able to avoid making unnecessary payments.

Looking for Common Errors

Medical bills can read like they’re written in a foreign language. It can be hard to spot mistakes when you aren’t clear about what you’re looking for. When inaccuracies emerge, they can either be purposeful or genuinely accidental. Either way, there are some frequent errors you may want to keep an eye out for.

The Bill Never Went to Your Insurance Company

If you have insurance, making sure your provider submitted a timely claim to the insurance company can be a good first step to take. Occasionally, providers may neglect to send the bill to your insurance company at all and charge you for the entire amount.

Your claim could also be denied if the provider didn’t have the right insurance information for you—even if the ID is off by just one digit. You’re already paying an insurance premium, so paying for the entire procedure out-of-pocket could boost your overall medical costs.

You Were Charged for Services You Didn’t Receive

You may have to ask for an itemized list of all the charges in your bill, but reviewing that you are only being billed for services or treatments that you actually received may be wise.

You may also want to confirm that the quantities are also correct—so you’re not being billed for two MRI scans when you only got one. The itemized bill should include prices, so checking that no extra zeros got added on by mistake may be a good step in this process.

Pay for medical costs—without
sinking into high-interest debt.


The Wrong Billing Code Was Used

If your insurer denied coverage for a procedure or medication, you may be able to identify the correct billing code and request that the provider refile the claim. If you have questions about the codes used, checking with the medical provider and insurer may save you some research time.

One type of billing code error is known as upcoding. This is when the provider bills for a longer session than was provided (for example, a 60-minute session when he or she only saw you for 15 minutes). Another common error is known as unbundling, which refers to using codes for each component part of a procedure rather than a single code that covers them all.

Correcting Medical Billing Errors

If you find an error during your hospital bill review, you may be able to file an appeal with your insurer. Appeal instructions can usually be found on the explanation of benefits received from your insurance company.

Documentation to back up your appeal, such as medical records, can often help strengthen your case. The Patient Advocate Foundation offers a detailed guide to the appeal process, including sample letters.

Insurers may provide a decision within two months. If you disagree with the decision, you can ask for an independent review—your insurer should provide you with information on how to do this.

If your appeals don’t go anywhere, you may wish to turn to one of several advocacy groups . For example, the Patient Advocate Foundation offers one-on-one assistance at no charge and its website also lists organizations that provide help for people with specific conditions. Seniors with Medicare can access free counseling through the State Health Insurance Assistance Program .

If you’re still stuck, hiring a medical billing advocate to represent you may be helpful. These professionals typically charge at least $100 an hour or take 25% to 35% of the money they save you.

Options for Paying Off Medical Bills

Even if you find errors in your medical bills and are able to resolve them, chances are this won’t eliminate what you owe entirely. Here are some ways you can approach paying off medical debt:

Negotiating a Reduced Bill or Payment Plan

Even if your bills don’t include any mistakes, they aren’t necessarily set in stone. If you’re having trouble making a payment, calling your provider’s billing department and explaining your situation may be the best first step to take.

Some may be willing to negotiate your medical bills and lower your fees if you make the payment in cash or in a lump sum.

You may be able to gain additional leverage by arguing, politely and accurately, that the provider charged an unfair rate, bolstered by research on average prices in your area and what Medicare allows for the service.

Even if you can’t get your payment reduced, you may be able to extend the due date. Many providers and hospitals will work with you to set up an affordable payment plan, sometimes without charging interest.

Budgeting for the Unexpected

Medical bills can pack an unexpected punch to an already tight budget. If you’ve already used some of the strategies to reduce what you owe, it might be necessary to reduce expenses or increase income while you pay medical bills.
Taking a look at current spending is a good place to start, determining whether there is nonessential spending that could be put toward what is owed.

If there is absolutely no wiggle room at all, you might consider increasing your income by taking on a side hustle or asking for a raise. Once you find a way to include medical payments into your budget, tracking your spending could be a helpful way to make sure you have the funds available each month.

Taking Out a Personal Loan

A personal loan can be a smart way for many people to pay off medical debt. Unlike a home equity line of credit (HELOC), a personal loan is typically unsecured, meaning you are not putting your home or any other asset on the line.

A personal loan can be used for many purposes—including paying off medical bills—but typically comes with much lower interest rates than credit cards or payday loans.

With SoFi, you may be eligible for a personal loan of $5,000 to $100,000 at competitive interest rates, with no fees for taking out the loan or paying it off early.

Ready to get a handle on your medical debt? It takes just a few minutes to check your rate for a medical loan to pay off your medical bills.


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Financial Tips & Strategies: The tips provided on this website are of a general nature and do not take into account your specific objectives, financial situation, and needs. You should always consider their appropriateness given your own circumstances.
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