How to spot medical billing errors

Nicole Broadhurst |

This post was written for Thatch by Nicole Broadhurst. Nicole is a patient advocate at Tennessee Health Advocates; she's been in the healthcare field for more than 20 years.

Have you ever caught an error in your medical bill? Chances are, even if you haven’t caught one, they’ve been there. It’s reported that between 75% and 80% of medical bills have errors. With a rate that high, everyone should know how to identify errors on medical bills. While they may seem hidden and hard to find underneath all the technical jargon of the industry, there are some simple steps you can take to help catch errors in your medical bills.

Steps to take every time you get a medical bill

Following these steps early in the process will help identify errors and prevent overpayment for healthcare services. Starting early is the key to success.

1. Request medical records immediately following appointments

When checking out from your appointment, request the visit notes and superbill while you are at the front desk. A superbill is the document your doctor and nurse use to officially document the procedure codes for the services provided during your visit. The visit notes and superbill will contain important information about the services you received during your visit. Having these notes will be helpful when reviewing bills against the services you received.

2. Track medical expenses as they occur

Create and maintain a document or a spreadsheet and enter all medical expenses as they occur. For example, if you have your annual physical, you would add the date of your appointment, the physician you saw, and the code from the superbill to your document right after the appointment. This provides a much-needed tracking mechanism to help when the bills and explanation of benefits (EOB) start to arrive in the mail. Creating a corresponding file on your computer (or filing cabinet) is helpful to keep track of the actual documents. It also assists in identifying and tracking the correct (or incorrect) application of charges to your deductible and out of pocket responsibilities. You can make sure you’re not paying for services you didn’t receive by simply tracking healthcare expenses as they occur.

3. Review your insurance EOB against the provider bill

Every time you have a medical expense, you should be on the lookout for two separate documents, the bill from your provider (doctor, hospital, etc.) and the EOB from your insurance company. Reviewing the EOB against the bill from the provider can quickly reveal some common errors. The most important thing during this review is to ensure the patient responsibility amount on the EOB matches the amount billed by the provider. If these amounts don’t match, there may be an error.

What to do if you think there’s an error in your medical bill

If you think there might be an error in your medical bill, here are some simple suggestions to get it clarified and resolved.

1. Ask for an itemized statement & the insurance claim form

Call your provider’s billing department and tell them you are concerned there might be an error. Inform them the information from your insurance does not match the bill and you would like to review the itemized statement and claim form before making payment. This is also a good time to request additional time to pay the bill if that would be helpful to you.

2. Ask the provider billing department for help

If you are not able to find the error once you receive the itemized statement and the claim form, you can ask for help. You can call your provider’s billing department and ask them to explain the situation so you better understand why your bill doesn’t match the EOB.

3. Seek external billing help

If the provider billing department is unable to explain the situation so you understand it, or the explanation creates more confusion, it might be time to seek support elsewhere. Luckily, there are independent patient advocates who specialize in medical billing errors.

Be your own advocate by being prepared

These simple suggestions will help you identify and correct a large percentage of medical billing errors. If you take the actions suggested above and still believe there might be an error in your medical bill, reach out for professional assistance. Some medical billing errors will be found quickly and easily by someone with experience in the medical billing industry. If your employer uses Thatch, you have access to medical billing experts whenever you need them, at no cost to you. To learn more about patient advocacy for startups, get in touch.

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