How To Dispute a Medical Bill With Your Doctor Or Hospital

How To Dispute a Medical Bill With Your Doctor Or Hospital:

Health care billing is a carefully regulated industry and there are many state and federal rules for handling patient’s complaints and appeals.  As many as eight out of ten medical bills contain billing errors and lead to health care disputes. Most health insurance companies will initiate an internal review of the disputed claim. Hospitals and physicians offices also initiate their own internal reviews to control the amount of billing errors made to minimize the amount of health care disputes. Several states have other reviews that take an unbiased approach to solving disagreements with health care providers in a civil way.  There are several steps to take to insure that the matter is handled correctly and effectively to minimize the occurrence of health care disputes.

  • When a billing error is noticed it is important to request an itemized statement from the billing company, whether it is from the hospital itself or the physician.  The best way to insure accuracy is to request the month of and up to four months after the discrepancy since some insurance companies can take longer than others to process claims.
  • Once the itemized statement comes in the mail, read each line meticulously. A transaction charge will be listed for each treatment that was given and received along with a detailed list of the cost of the procedure, what the insurance company paid, and what the patient owes.
  • Write down each discrepancy on a piece of paper and list the date of service received. Most health care disputes involve charges for procedures never received by patients. The easiest to spot are large charges like x-rays or magnetic resonance imaging and are often charged to the wrong patient. Smaller errors include medications given and blood testing procedures. Mail this to the health care provider so that they have a copy in writing of the health care dispute.
  • The next step to take is to call the company responsible, whether that is the physician, the practice, or a larger provider like a hospital. Get in contact with the billing department and ask a health informatics technician to make a correction. Every call should be meticulously documented including the name of the person spoken to. Many hospitals often perform several hundred internal reviews a day.
  • Health care disputes also take several weeks if not months to resolve, so it is important to pay the portion of the bill not handled in the dispute to prevent it from going into collections. Write to the credit bureaus to inform them that there is a dispute to insure that credit records are kept as accurately as possible.

The best way to solve billing disputes is to prevent them altogether.  Patient records are often coded and abstracted hours after the procedure is performed and if there is a discrepancy in the physicians notes he or she may often not recall what was exactly performed. A great way to prevent a possible health care dispute is to call the insurance company before the procedure is performed. The best way to prevent errors is to be well informed of the charges so that when the bill arrives it is easy to spot a mistake and start the appeals process.

Health care disputes can often drive up the cost of health care including insurance premiums because often billions of dollars in fraud or mistakes occur on a yearly basis. Some insurance companies offer cash rewards or incentives to consumers who catch these errors. Health care disputes can be lengthy procedures often spanning many months so it is essential to start the process as early as possible. Hospitals and physician’s offices spend a large portion of their budget on quality control and personnel to handle these health care disputes and often encourage patients to practice billing awareness.

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