Different seasons of life come with different challenges. One constant, no matter the season, is health care. You may have years with less medical bills and some with more, but it is something ever present.
You should never pay a medical bill without carefully reviewing it first. Mistakes are rampant and if you don’t hold your provider accountable, who will? Take some time to review a bill for accuracy to ensure you are not paying the wrong amount. Let’s get started on how to read a medical insurance bill.
"A false balance is an abomination to the LORD, but a just weight is his delight." Proverbs 11:1 ESV
Is this my bill?
This might sound ridiculous, but this is an important first step. Check the full name of both the family member who received care and the full name of the insured family member. Also make sure the address or other identifying information on the bill is correct. Take special care if you have family members with similar names. For example, if Dad is Bill Smith Sr. and Bill Smith Jr. is his son, a mix-up can happen.
Mistakes like name errors can cause problems with your insurance. A common scenario is many plans will have a deductible that is two-tiered. One deductible is tracked by how much is spent for an individual and another is the overall amount for your household. It’s important to keep this accurate for the medical provider and your insurance provider.
Some medical providers will also have a number to identify the patient, insured party, or perhaps both. Use this, sometimes called a patient ID number, as another check to make sure everything lines up.
Validate your insurance info
Some medical bills will have insurance information printed on the invoice or statement. Take time here again to validate the correct name is listed here. This could be referred to as something like “insured party” or “responsible person” Make sure the right person is listed here and their name is formatted in the same way the insurance company has it on their records. If the name of the insurer is listed, validate this as well. Blue Cross Blue Shield of North Dakota and Blue Cross Blue Shield of North Carolina can be easily mixed up and cause problems. If a policy or group number is listed, check this as well.
Blue Cross Blue Shield of North Dakota and Blue Cross Blue Shield of North Carolina can be easily mixed up and cause problems.
Who provided care?
This is another line item that is easily overlooked. Is the correct hospital listed? Is the right facility mentioned that you visited? Confirm this information lines up with the care that was administered. This can be confusing because the many parties that sometimes work out of a facility like the hospital. For example, the bill may be from a medical practice that operates out of a hospital, but the bill does not reference the hospital itself. If a specific doctor or other medical professional is listed, check that as well.
What care was provided and what was charged?
Next, review the services the bill says were provided. Keep in mind if you saw multiple doctors or had a lengthy hospital stay, this could be broken up with several bills. As an example, if you had surgery you could receive a bill from the surgeon, anesthesiologist, and hospital all separately and at different times. With that caveat, review the services they list and are requesting payment on.
Most medical bills you receive are a summary of what was done. To get a true read on how the billing department arrived at the number, you’ll likely have to contact the provider and ask for an itemized bill. The itemized bill is the real bill.
Crack the Code
Next a word on coding you will see. This can be intimidating when you first see it. Most of the coding on your bill is standardized and can be easily searched online to translate into English. These codes will only appear on a detailed bill.
There will be different codes for each line on the itemized bill. These include HCPCS Level I (also known CPT Codes or services codes). These denote a procedure or test. Another level for this code is HCPCS Level II codes which correspond to medical supplies. Next, look for ICD-10 codes. These codes indicate a diagnosis. It's common to have multiple line items that have the same diagnosis, but different services for each line. Take time for confirm you are not being double charged for a medicine or care you did not actually receive.
If there is an error
Since medical billing errors are unfortunately so common, the odds are that you will experience this at some point in your family. First, call your insurance company and ask them to compare what was filed with the bill you received. Your insurance carrier will often catch errors because they have a financial incentive. They may already be in the process of a dispute by the time you catch it. If that’s not the case, then it’s time to call the billing department that produced the bill.
If your insurance company is not already engaged in correcting the bill on your behalf, it’s time to contact the billing department that sent you the bill. Have notes prepared before you contact them and be specific with what you believe the mistake to be. Remember, you do have the right to expect accuracy and a detailed explanation for medical billing.
A word about bedside manner
When you reach someone to discuss your bill, be comfortable with being firm and specific with what you are asking them to do. This is reasonable. That being said, don’t allow any frustration with the process or a mistake to turn into a less than pleasant conversation. Pressing for a resolution does not require a less than friendly conversation. It will be better for you and better for the person that answered the phone.
If you determine that a correction is warranted and will be made, get specifics on a few things. When will you receive a corrected bill or invoice? What, specifically, will be corrected? Will the corrected copy be marked “corrected”, “revised”, or in some way denote that an amendment was made from the original version? Also, make note of the person that promised this and the date you spoke with them. If you continue to face challenges when you’re confident an error was made, consider asking for help. Some cases call for a third party to help intervene on your behalf. Both for-profit and non-profit organizations help in cases of medical billing errors and unsuccessful disputes. Some are free and some are not. The Patient Advocate Foundation has some resources that can help you get started for free.
I realize this is not the type of leisure reading anyone would choose. The extra time is worth it. If you think it's worth it to check your receipt at the grocery store, then it's worth it to check the bill for your family's doctor visits.
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